* 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.