2022 Camp Registrations ……………….…. (1 student)

2022 Summer Chess Camps

1 Student Registration Form ..... All 5 Camps Use This Form
Student Name: *

First Name Last Name
Upcoming Grade: *
School: *
Gender: *

Male Female
Parent Name: *

First Name Last Name
Parent Email: *
Parent Phone Number: *
Parent Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Has your child played in a chess tournament before? *

Yes No
Has your child played in a RATED chess tournament? *

Yes No
These Chess camps include a US Chess rated tournament

Every player must have a current membership in the the United States Chess Federation to participate in these camps. If you do not have a membership ID please go to their website www.USChess.org and click on the join tab.

Student memberships are $20 and are good for 12 months of tournaments.
USCF Membership ID Number: *
Expiration Date: *

Month Day Year
Date
Current Rating *
If first rated tournament type: UNRATED
If you don't know your child's ID number, rating, etc?

Go to link: https://new.uschess.org/players/search/
Coach's Name: (optional)
Any allergies, or special concerns we should know about.
Parent agrees to provide lunch for their child *

Yes, I will provide lunch and drinks each day for my student.
Pool time is supervised by 2 staff members at all times. Can your child swim? *

Yes, my child can swim No, my child can not swim, but is not afraid of the water No, my child will not go in water
Please list persons authorized to pickup your child: *
How did you hear about these camps? *

Child attended previous camps by the Alton's Current Alton Academy 4 Chess Student From Friend From Coach From Goggle
Any additional information you would like to provide:
Health Policy:

- All coaches have received the Covid vacine

- Hand sanitizer bottles are placed at every chessboard and required

through out the day

- No sharing of drinks or food is allowed

- Many campers wear masks, but masks are optional
PARENT HEALTH WAIVER - Our family home has not experienced the Covid-19 virus in the past month and my child is healthy and able to participate in this camp *

Yes, my child is healthy
Agree to Sign a Liability Waver *

Yes, I am the parent of the above student, and I agree to sign a liability waver for all chess camps my child attends.
Cancellation Policy:
A cancellation fee of $75 will be deducted from the amount refunded if cancellation is made more than seven days in advance of the first day of camp. No refunds are given if cancellation is made less than seven days prior to the first day of camp. Our camps are small and do fill up we want them availible to as many students as possible. Thank you for your understanding.
Do you need extended care for your child? *

No .... 9:30 - 3:30 works for our family Yes, morning care needed for some camp days Yes, morning care is needed all camp days Yes, after care some days Yes, after care all of the days
Extended care for your child is extra $10-15 for morning and $10-15 for afternoons. Please tell us what you need? Payment is separate from camp registration. *
"Chess Makes Kids Smart, We Make it Fun!"

2022 Camps - 5 different one week camps offered:
Please select as many camps you are interested in for your child. This form is for 1 child registration. All camps are 5 days.

Camp Location .... Alton's Family Home

ADDRESS:

5502 Pine Bay Dr.

Tampa, FL. 33625
Chess Camps are filling up!

Camp #1 June 6th-10th ... FULL

Camp #2 June 13th - 17th ... FULL

Camp #3 June 20th - 24th ... 6 Spots OPEN

Camp #4 July 18th - 22nd ... 4 Spots OPEN

Camp #5 July 25th - 29th ... 3 Spots OPEN

Registration for Chess Camps: *

Week 3 ... June 20th - 24th $ 295.00

Week 4 ... July 18th - 22nd $ 295.00

Week 5 ... July 25th - 29th $ 295.00

Total $ 0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Please Contact System Administrator

Please Contact Tournament Director - Krista Alton @ kristaalton@yahoo.com
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2022 Summer Chess Camps

Please Contact System Administrator