Leeds Junior Chess Club Waiting List

Leeds Junior Chess Club Waiting List
CHILD INFORMATION:
Child Name *

First Name Last Name
Birth Date *

Month Day Year
School Year *
Name of School *
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Phone Number *

Area Code Phone Number
E-mail *
example@example.com
Mobile Phone
Please state any special needs and previous chess experience.
Should be Empty:

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