Saturday Chess Program

SATURDAY CHESS PROGRAM REGISTRATION
Student Information
Student Name

First NameLast Name
Birth Date

MonthDayYear
School
Gender

MaleFemale
Grade
Student Email
example@example.com
Parent/Guardian Information
Name

First NameLast Name
Home Number
E-mail
example@example.com
Relationship
Emergency Information
Emergency Contact's Name

First NameLast Name
Cell Number
Phone Number
Packages Being offered
prevnext( X )
REGISTRATION FEE
2,000.00JMD



Package 1 - 5 Activities
55,000.00JMD



Package 2 - 4 Activities
48,000.00JMD



Package 3 - 3 Activities
40,000.00JMD



Package 4 - 2 Activities
30,000.00JMD



Chess (9:00am - 11:00am)
16,000.00JMD



KARATE (10am - 11am)
16,000.00JMD



CHESS (11:00am - 1:00pm)
16,000.00JMD



SWIMMING (1:00pm - 2:00pm)
20,000.00JMD



ROBOTICS & CODING (2:00pm - 3:00pm)
16,000.00JMD



Music ( 11:00am - 12:00pm)
16,000.00JMD



Total

0.00JMD
Alt. Phone Number
Is the student prescribed an inhaler? If yes, please explain any instructions.
Does the student have any allergies, chronic illness, or medical conditions? If yes, please describe.
Lunch Arrangements
Please select an option for Lunch
BANK TRANSFER CAN BE MADE TO:
Type: Personal/savings
First Name: Melisha
Last Name: Smith
Branch Name: Scotia Bank
Branch: Half Way Tree
Branch Transit: 60145
Account Number 100906975
Account Currency: JMD
Payment Options
Payment options

Bank TransferPay to Organizer
All Covid protocol must be follow.
Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Should be Empty:

SATURDAY CHESS PROGRAM REGISTRATION

Lunch Arrangements

Payment Options