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Sacred Heart Chess Club Registration
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Step
1
of 4
Parent Name
*
First
Last
Email
*
Phone
*
Student Name
*
First
Last
Student Grade
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other (I have received prior approval)
Has this student participated in a DMCA chess club previously?
*
Yes
No
Please describe their chess experience
Session Selection
*
Session 2 (Jan 23 - Mar 19) - $ 99.00
Session 3 (Mar 23 - May 14) - $ 99.00
Session 2 & 3 (Jan 23 - May 14) - $ 179.00
Total
$ 0.00
Next
Would you like to register another student?
Yes
No
Student Name
*
First
Last
Student Grade
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other (I have received prior approval)
Has this student participated in a DMCA chess club previously?
*
Yes
No
Please describe their chess experience
Session Selection
*
Session 2 (Jan 23 - Mar 19) - $ 99.00
Session 3 (Mar 23 - May 14) - $ 99.00
Session 2 & 3 (Jan 23 - May 14) - $ 179.00
Would you like to register another student?
Yes
No
Student Name
*
First
Last
Student Grade
*
3rd Grade
4th Grade
5th Grade
6th Grade
7th Grade
8th Grade
Other (I have received prior approval)
Has this student participated in a DMCA chess club previously?
*
Yes
No
Please describe their chess experience
Session Selection
*
Session 2 (Jan 23 - Mar 19) - $ 99.00
Session 3 (Mar 23 - May 14) - $ 99.00
Session 2 & 3 (Jan 23 - May 14) - $ 179.00
Total
$ 0.00
Next
Emergency Contact
*
First
Last
Relationship to student
Phone
*
Comments or additional info
Next
Total
$ 0.00
Stripe Credit Card
*
Card
Name on Card
Submit Secure Payment
