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Chess Class REGISTRATION form

* Indicates required field

Student Name *

First

Last

Birthdate *

Gender *

Male Female

2017 Fall - 2018 Spring School Name *

Grade in Fall 2017 *

Father's Name *

First

Last

Father's Email *

Father's Phone Number *

Mother's Name *

First

Last

Mother's Email *

Mother's Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

2017 Summer Chess Class Session 1 (Week of June 26 - Week of July 24, No class on week of July 3rd) *

Chess Beginning - Wednesday (GK - up) Chess Intermediate - Thursday (G2 - up) Chess Advanced - Friday (G3 - up)

Choose One *

Fall 2016 and Spring 2017 - Friday Class - $15 off ( $405) Option 2 Option 3

2017 Summer Chess Class Session 2 (Week of July 30 - Week of Aug 21) *

Chess Beginning - ( GK - up) Chess Intermediate - Thursday ( G2 - up) Chess Advanced - Friday ( G3 - up)

Payment Method *

Choose One *

Option 1 Option 2 Option 3

Comments or Questions *

Late Payment Agreement

I agree to pay tuition by the agreed upon date, understanding that failure to pay on time will result in a late payment fee of $50 or 20%, whichever is lower. *

I agree.

Submit

note: Art Program registration please go to www.cier-art.com

CHAMPION
EDUCATION

106 Pheasant Wood Court
Morrisville, NC 27560

(919) 388 1739
[email protected]