2025 Camp Registrations ……………Northwest Church (year 2) ....….…. (1 student)

2025 Summer Super Chess Camps!

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

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

MaleFemale
Parent Name:*

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

Street Address

Street Address Line 2

CityState / Province

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

YesNo
Has your child played in a RATED chess tournament?*

YesNo
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:*

MonthDayYear
Date
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.
Please list persons authorized to pickup your child:*
How did you hear about these camps?*

Child attended previous camps by the Alton'sCurrent Alton Academy 4 Chess StudentFrom FriendFrom Another CoachFrom GoggleFrom PCS Experience
Any additional information you would like to provide:
Safety/Health Policy:

- All students will be supervised by an adult staff member at all times.

- We will have full use of the Church building and grounds ... No other adults will be on grounds during camp hours.

- All adults have a level 2 background check.

- Hand sanitizer bottles are placed at multiple tables

- No sharing of drinks or food is allowed
PARENT HEALTH WAIVER - My child is healthy and able to participate in this camp*

Yes, my child is healthy, and if they become sick I will not bring them to camp that day.
Agree to Sign a Liability Waver (waver signing will be on the 1st day of camp)*

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 familyYes, morning care needed for some camp daysYes, morning care is needed all camp daysYes, after care some daysYes, 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!"

2025 Camps - 4 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 ....

Northwest Community Church

14913 Hutchinson Rd

Tampa, FL. 33625
Chess camps will sell out! Only 20 Students!

Camp #1 ....... June 2nd - 6th ........... 2 Spots Left

Camp #2 ....... June 9th - 13th ........... OPEN

Camp #3 ....... June 23rd - 27th ......... OPEN

Camp #4 ....... July 21st - 25th ........... OPEN

Buy 1 week camp for $350

Buy 2 weeks of camps for $650 ......... Save $50

Buy additional weeks for more savings!

Check out all the options below...
Notation Books:

Chess Camp will teach notation every day at camp.

Students need to bring their Chess notation book to camp or purchase a notation book from the coaches.

Notation Book ...... Soft Cover ................ $5

Notation Book ...... Hard Cover ............... $10

My Products*

Week 1 ... June 2 - 6

$350.00

Week 2 ... June 9 - 13

$350.00

Week 3 ... June 23 -27

$350.00

Week 4 ... July 21 -25

$350.00

Buy 2 Weeks ........ Save $50Please indicate which camp weeks you are buying in the box below

$650.00

Buy 3 Weeks ........ Save $75Please indicate which camp weeks you are purchasing in the box below

$975.00

Buy 4 Weeks ........ Save $100*Your student will also receive 2 private lessons during camp hours... an additional savings of $120

$1,300.00

Buy Chess Notation Book ... Soft CoverBook delivered at 1st day of camp

$5.00

Buy Chess Notation Book ... Hard CoverBook delivered 1st day of camp

$10.00

Total

$0.00

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

Which multiple camps are you purchasing? EXAMPLE: Weeks 1 and 3*
Please Contact System Administrator

Please Contact Tournament Director - Krista Alton @ kristaalton@yahoo.com
Should be Empty:

2025 Summer Super Chess Camps!

Please Contact System Administrator