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Registration for Chess club:
*
Indicates required field
Child Name
*
First
Last
Child Grade
*
2
3
4
5
Child teacher
*
Choose from the list
Atienza
Green
Kaufmann
Pressley
Tinker
Miller
Ritterman
Sambor
Stewart
Whalon
Antonelli
Doran
Oppenheim
Popko
Boyer
Friedlander
Lawson
Morton
Parent/guardian Name
*
First
Last
Emergency Contact (Name and Phone Number)
*
Emergency Contact 2 (Name and Phone Number)
*
Email
*
Phone Number
*
All reasonable precautions are taken to assure your child's safety and prevent injuries from occurring. If an incident should occur, you grant permission for the instructor, school or HSA to obtain emergency medical care if it appears necessary.
Agreement to the term
*
"I have read and agree to the terms outlined above."
Comment
*
After you click on the Submit button you will be redirected onto the Shining Knights company website where you will be able to pay the club fees.
If you require financial assistance, please email Anne Heffron at heffroa@lmsd.org as soon as possible .
Submit