Chess Fest Online Entry Form If you are a human and are seeing this field, please leave it blank. Fields marked with an * are required Information requested on this form is for the exclusive use of Cincinnati Scholastic Chess, which will not give, sell, make available or otherwise share this information to or with any other organization or individual except as required by law. CONTACT INFORMATION Parent/guardian name * Street Address City State Alabama Alaska Arizona Arkansas 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 Zip Code * Having your contact information enables us to communicate with you if we have any questions about your registration and to notify you if there are any changes regarding the event. Primary phone number with area code * Primary email address * Secondary phone number with area code Secondary email address CAMPER INFORMATION Name * 2019-20 Grade * 1 2 3 4 5 6 7 8 Select Class * Depending on the number of campers registering for each class, we will create multiple sections of a class as necessary. Beginner 1 - $85Beginner 2 - $85Intermediate - $85Advanced - $85 Total Payable Please note that this charge will show up on your statement as “PayPal Chess Fee”. WAIVER AND SIGNATURE I (Parent/Guardian) acknowledge that the organizers of the Mason Chess Fest will take all reasonable precautions customary and usual to conducting such a chess camp, and beyond this I assume any risk associated with my child’s participation in it. I understand that the camp organizers, camp teachers, camp staff, Heritage Presbyterian Church, and its staff are not to be held responsible in case of accident, and I agree to hold same harmless in the event of accident. In the event of a medical emergency, I hereby authorize emergency medical treatment for my child (if deemed necessary by a physician) if I am not at the chess camp venue and cannot be reached at the telephone number(s) listed below. Phone number for emergency contact * Alternative phone number for emergency contact Signature * The parent's/guardian's name here indicates acceptance of waiver and authorizes submission of this entry form. Click on the button below to submit your registration and proceed to the payment page.