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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 20 - June 24, 2011
June 27 - July 01, 2011
July 05 – July 08, 2011
July 11 - July 15, 2011
July 18 - July 22, 2011
July 25 - July 29, 2011
Aug. 01 - Aug. 05, 2011
Aug. 8 - Aug. 12, 2011
Aug. 15 - Aug. 19, 2011
Aug. 22 - Aug. 26, 2011

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.