Chess Lessons with Martin Sobin (Beginners or Previous Chess Experience)

1. Child’s name or nickname (please indicate the name your child would like to have the librarian use when taking attendance)

Child’s name or nickname (please indicate the name your child would like to have the librarian use when taking attendance)

2. Child's age

Child's age

3. First and last name of Parent or Caregiver accompanying the child

First and last name of Parent or Caregiver accompanying the child

4. Have you taken chess lessons in the past?

Have you taken chess lessons in the past? Yes

5. Please indicate the lessons you plan to attend:

	Beginner (no previous lessons) - 4:15-5:15	Previous chess lessons - 5:30-7:00
Wednesday, 2/6	*Please indicate the lessons you plan to attend: Wednesday, 2/6 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 2/6 Previous chess lessons - 5:30-7:00
Wednesday, 2/13	Wednesday, 2/13 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 2/13 Previous chess lessons - 5:30-7:00
Wednesday, 2/20	Wednesday, 2/20 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 2/20 Previous chess lessons - 5:30-7:00
Wednesday, 2/27	Wednesday, 2/27 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 2/27 Previous chess lessons - 5:30-7:00
Wednesday, 3/6	Wednesday, 3/6 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 3/6 Previous chess lessons - 5:30-7:00
Wednesday, 3/13	Wednesday, 3/13 Beginner (no previous lessons) - 4:15-5:15	Wednesday, 3/13 Previous chess lessons - 5:30-7:00

6. Telephone

Telephone

7. Telephone number of another parent/caregiver for emergencies

Telephone number of another parent/caregiver for emergencies

8. Does your child have any health-related problems or allergies to food, glue, crayons, etc.?

Does your child have any health-related problems or allergies to food, glue, crayons, etc.? Yes

9. If you answered yes, please comment:

If you answered yes, please comment:

10. E-Mail Address (only if you prefer we contact you this way)

E-Mail Address (only if you prefer we contact you this way)

11. Thank you for registering!

I understand that parents/caregivers must remain in the library at all times with children aged ten and under.

Thank you for registering! I understand that parents/caregivers must remain in the library at all times with children aged ten and under. I agree

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