Deer Park Chess Club Registration
9 Week Session (January 15th to March 11th)
Child Name:
First Name
Last Name
Grade:
Teacher:
Parent Name:
First Name
Last Name
Primary Contact Number:
-
Area Code
Phone Number
Secondary Contact Number:
-
Area Code
Phone Number
Email Address:
example@example.com
After club designation:
HOST
Car Line
Other
Payment:
*
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Deer Park Chess Club Spring Session
$95.00
$
95.00
Total
$0.00
$
0.00
Credit Card
Submit
Should be Empty: