Ealing Junior Chess Club Registration Form

Student Registration Form

Fill out the form carefully for registration
Student Name

First NameLast Name
Birth Date

DayMonthYear
Gender
School
Parent / Guardian Name

First NameLast Name
Phone Number

Area CodePhone Number
Parent / Guardian E-mail
example@example.com
Address

Street Address

Street Address Line 2

CityPost Code

Zip CodeCountry
Which Ealing Junior Chess Club date are you joining ?
Any additional information / Child Allergies:
I give permission to take photographs and / or video of my child. I grant full rights to use the images resulting from the photography/video filming, and any reproductions or adaptations of the images for fundraising, publicity or other purposes to help achieve the group's aims.
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Student Registration Form