WAITING LIST Deer Park Chess Club 1/15-3/11

WAITING LIST: Deer Park Chess Club

9 Week Session (January 15th to March 11th)
Child Name:

First NameLast Name
Grade:
Teacher:
Parent Name:

First NameLast Name
Primary Contact Number:

Area CodePhone Number
Secondary Contact Number:

Area CodePhone Number
Email Address:
example@example.com
After club designation:

HOSTCar LineOther
Should be Empty: