NEW HORIZONS CHESS

Welcome to the online registration form for the New Horizons chess program. Once you have completed this form, please press the "Continue" button on the bottom of the form - you will then have a chance to review a summary of your registration info before finally submitting it.

*** UPDATE - Please note this class is for BEGINNERS only.

**************************************************************

STUDENT'S FIRST NAME: MIDDLE INITIAL: LAST NAME:
PARENT'S NAME:
STREET ADDRESS:
CITY: ZIP:
TELEPHONE: (please include area code)
EMERGENCY TELEPHONE:
PARENT'S E-MAIL:
STUDENT'S DATE OF BIRTH:

GRADE:

AFTER-CLASS PICK-UP:

All students will need to be picked up promptly after class at the designated pick-up location on campus. If you have arranged for your child to walk home or you'd like to share any additional information with regards to your child's pick-up (e.g. returning to on-site daycare), please let us know below.

Pick-Up Comments (optional):

PARENT ACKNOWLEDGEMENT:

I hereby, as the Parent/Guardian, give my child permission to participate in the Success Chess Program held at New Horizons. I recognize that this program is under the direction of Success Chess School and is in no way connected to New Horizons and only Success Chess can be held legally responsible for this program. I also understand the Success Chess refund policy, which states that a prorated refund will be granted for any reason if requested before the 3rd class session of the first semester, but that no refunds will be granted past that time. If my child can no longer permanently attend chess class during the school year due to unforeseen circumstances, I agree to immediately inform Success Chess and understand that depending on the circumstances involved, Success Chess may issue a credit for future classes at its discretion.

Electronic Signature of parent or guardian: Date:

SELECT YOUR CHILD'S CHESS LEVEL:

Beginner--has never taken a chess class, with little to no knowledge of chess
Intermediate--has played chess before or taken a chess class, knows how the chess pieces move and how to castle (*not offered for this class)
Advanced--has taken 2 or more years of chess classes (*not offered for this class)

HAS YOUR CHILD BEEN IN A SUCCESS CHESS CLASS BEFORE?

If this is the first chess class for your child, select 'NO' here. If your child took chess class last year, select 'YES,' and we will carry over any rankings and points accumulated in past Success Chess classes.

If you answered yes, but your child attended a Success Chess program at a school
other than New Horizons, please indicate the school:

SELECT YOUR PAYMENT:

For the Spring semester, the cost is $245 (Second child = $235, Third child = $225)

SELECT PAYMENT OPTION (CREDIT CARD OR CHECK):

If paying by credit card, please fill out information below, and note that the billing address on the credit card should be the same as the address you entered at the top of this registration form. If paying by check, please mail your payment to: SUCCESS CHESS SCHOOL, NEW HORIZONS CHESS, 5001 ROYAL PALM DRIVE, FREMONT, CA 94538. On your check, please include your child's name and school, plus your phone number in case we have any questions. Your child's registration will not be complete until we receive your payment.

Select a Credit Card type: *

Credit Card Number (Please enter number with no spaces or dashes, e.g. 3423765423484921):*

CVV Number (For Visa & Mastercard, the last 3 digits in the signature area on the back of the card; for American Express, the 4 digits above the credit card number on the front of the card) : *

Exp. Month: * Exp. Year: *

Name on card: *