* 1. Would you be willing to make a donation to the Bernardsville Library to help defray some of the costs of these free lessons?

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

* 3. Child's age

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

* 5. Have you taken chess lessons in the past?

* 6. Please indicate the lessons you plan to attend.

  Beginner (no previous lessons) - 4:30-5:30 Previous chess lessons - 5:30-7:00
Wednesday, 1/21
Wednesday, 1/28
Wednesday, 2/4
Wednesday, 2/18
Wednesday, 2/25

* 7. Telephone

* 8. Telephone number of another parent/caregiver for emergencies

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

* 10. If you answered yes, please comment:

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

* 12. Thank you for registering!

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