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Day Camp Enroll Now

Child's Name:
Boy: Girl: Date of Birth (mm/dd/yy):

Camper's USCF Rating:

Parent Name:
Home Phone# Work Phone#
Email Address:
Address:
City: State: Zip Code:



Fee Schedule:

$110.00 - Due with Enrollment

Chess Camp times are 9am - 12pm

June 21 - June 25, 2010
June 28 - July 02, 2010
July 05 – July 09, 2010
July 12 - July 16, 2010
July 19 - July 23, 2010
July 26 - July 30, 2010
Aug. 02 - Aug. 06, 2010
Aug. 9 - Aug. 13, 2010
Aug. 16 - Aug. 20, 2010
Aug. 23 - Aug. 27, 2010

Afternoon Camp:


Purchase a T-Shirt:
(T-Shirts will be waiting for you at the Camp)

Size of First T-Shirt (Additional $15):

Size of Second T-Shirt (Additional $15):

Payment Method:
Visa Mastercard Discover
Credit card number: Exp (mm/yy):
Three Digit Code on the Signature Panel on the back of the card:
NAME (as it appears on credit card):


I approve this application and certify the applicant(s) capable of such an experience. I grant permission for the applicant to participate in all camp activities understanding that competent leadership will be provided. In case of accident the camp is authorized to secure emergency medical treatment. The camp is not responsible for lost, stolen or damaged personal articles. I authorize the camp to have and use photographs, slides and video tapes of the person(s) names on this application.