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Home
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Gift Certificates
/ Chess kNight
Chess kNight
$
3.00
Fun for Rookies and Chess Kings and Queens!
Thursdays 5:30-6:30
$3 at the door
All ages and experience levels welcome
—————————————-
Please fill out the form below once per participant
Registration Form
Student Name
*
Student Name
First
First
Last
Last
Which program are you registering for? (We use the same form for all programs. You telling us here helps us connect these forms to incoming payments.)
*
Student Birthdate
*
Student Age (at time of class/event)
*
Student Phone
*
Is the student's phone number the same as their legal guardian's?
*
Yes, it's the same
No (you'll be asked to enter the legal guardian's number in the next section)
Student Address
*
Student Address
Student Address
Student Address
City
City
State
State
Zip/Postal
Zip/Postal
Country
Afghanistan
Aland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei
Bulgaria
Burkina Faso
Burundi
Côte d'Ivoire
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands (Malvinas)
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Country
Is the student's address the same as their legal guardian's?
*
Yes, it's the same
No (you'll be asked to enter the legal guardian's address in the next section)
Legal Guardian
Legal Guardian Name
*
Legal Guardian Name
First
First
Last
Last
Main Contact Email
*
Secondary Email (for example if a different one is associated with your PayPal account).
Legal Guardian Phone
*
Legal Guardian Address
*
Legal Guardian Address
Legal Guardian Address
Legal Guardian Address
City
City
State
Alabama
Alaska
Arkansas
Arizona
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip/Postal
Zip/Postal
Besides the legal guardian listed above, is there anyone else you 'd like to list as an emergency contact?ional person listed as well?
*
Yes, there is someone else,. I'll list them below.
No, just the legal guardian listed above is fine
Additional Emergency Contact Name
*
Additional Emergency Contact Name
First
First
Last
Last
Additional Emergency Contact Relation to Student
*
Additional Emergency Contact Phone
*
Additional Information
Does your student have any allergies we should be aware of?
*
Yes
No
Allergies
*
List any allergies your child has and please list the reactions to those allergies:
Does your child have an EpiPen?
*
Yes
No
Is your child able to able to administer the EpiPen themselves?
*
Yes
No
Special accommodations or anything else we should know
List any special accommodations needed for your child or anything else you feel is beneficial for us to know. Or feel free to leave blank if there are none.
The Kaleidoscope Discovery Center
PLEASE READ CAREFULLY. THIS IS A LEGAL DOCUMENT THAT AFFECTS YOUR LEGAL RIGHTS.
Paragraph
Type your name if you agree with the waiver of liability and hold harmless agreement as stated above:
*
We may want to use photographs of your child in print or online material designed for news, informational or educational purposes related to The Kaleidoscope Discovery Center. Is this okay with you?
*
Yes, you're welcome to use photographs of my child
No, I do not grant permission for you to use photographs of my child
Don't forget to pay.
Your registration won't be complete unless you also pay for your program! IN addition to submitting this form you also need to "Add to Cart" below.
If you are human, leave this field blank.
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