Q300 Afterschool Lower Division (Sep 2023

Child's Information
Student's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Grade*
Allergies / anything we need to know?
Please select the sessions you would like to attend*
Skill Level*
Pick-up Time*

5:00 PM5:30-5:45 PMEarlier than 5:00 PM
ADD A SECOND CHILD?

Please check the button to add another child in the registration. A 5% sibling discount will automatically be applied.

2nd Child Information
Student's Name*

First NameMiddle NameLast Name
Birth Date*

MonthDayYear
Grade*
Allergies / anything we need to know?
Please select the sessions you would like to attend*
Skill Level*
Pick-up Time*

5:00 PM5:30-5:45 PMEarlier than 5:00 PM
ADD A THIRD CHILD?

Please check the button to add another child in the registration. A 5% sibling discount will automatically be applied.

Parent/Guardian's Information and Checkout
Parent/Guardian's Name*

First NameLast Name
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Emergency Contacts / Authorized Person to Pick-up
Additional Information
Subtotal
Enter coupon code
Apply remaining NYCA credit
Please enter the NYCA credit code
COUPON CODE DISCOUNT
CREDIT AMOUNT
** SUBTOTAL-COUPON-CREDIT **
Total discount
Coupon code and any applicable credit
Payment Plans

See other payment plan options. If you prefer to pay in full, please keep this field unchecked.

Total

USD

Pick-up Policy, Refund Policy and General Media Release*

I understand that all cancellations require at least 24 hours prior to the day of the program in order to receive full credit for the purchased amount to be applied toward any other NYCA programs. Credits never expire and are transferable. Refund requests are considered on a case by case basis. I hereby authorize New York Chess Academy (NYCA) to photograph, take motion pictures, video footage, and/or make electronic sound recordings of the participant I am registering. I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by the New York Chess Academy. I hereby acknowledge and agree to pay the late pick-up fee of $25 for each additional 15-minute delay in pick-up, after 5:45 PM. This fee can be paid directly to the instructor on the day of the late pick-up.
QUICK SURVEY: What activities would you like to have alongside Chess?

Math and Critical ThinkingArchitecture for Kids"How things are made"RoboticsVisual ArtsPerforming ArtsWeb Development and DesignCodingOther
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Q300 Afterschool Program (Lower Division)