Participant

First name*   Last Name*  

School Date of birth (MM/DD/YYYY)   Grade *  
Gender*   Male   Female   Email*   Phone*  Address Postal code City Province Comments (Alergies)

Parent/Guardian

First name*  Last name* 

Liability disclaimer: By submitting this form, I confirm that I am the parent or guardian of the chess player and I am registering my child for the chess club activities. I am aware of the nature of the activity, I know that there are inherent risks in any such activity, accept the risk of said activity and release Fraser Heights Chess Club from any and all claims for personal injuries and/or financial loss. Participants and parents of minor aged participants authorize coaches and supervisors of Fraser Heights Chess Club to seek medical treatment for the participant in the event of accident or emergency. Photos taken during programs may be used for promotional purposes and payment of fees and participation in this program shall constitute acceptance of this liability, medical and photographic release.