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Chess Club Registration

- Chess Club meets monthly to learn and play the fascinating game of chess. All levels and ages are welcome. Players from absolute beginners to tournament champions are welcome. All those attending, including parents bringing their children, are required to register individually (for example, a father and child both interested in attending must submit two separate forms). For any questions, please email Tobbyn Scott at [email protected]. We hope to see you there!
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  Participant First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Participant Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Birthday REQUIRED Please fill out this field. Please enter valid data.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
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  Email REQUIRED Please fill out this field. Please enter an email address.
  
  VIRTUS Verification (Adult Registrants Only)
  Check the box below to acknowledge that you are in compliance with archdiocesan VIRTUS requirements. If you are uncertain, contact the parish office at [email protected] before completing your registration.
  
  Certify Here I am in compliance with VIRTUS requirements. I am unsure and will contact the parish office.
  
  Further Information (if applicable)
  The remainder of this form only needs to be filled out for child registrants.
  
  To confirm an adult registrant only, check the box below: I verify that I am not registering any children for Chess Club.
  
  Adult registrants may scroll to the bottom of the form and click "submit." Parents registering a child should complete the rest of the form before submitting.
  
  Parent/Guardian Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
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  Medical Information
  
  Medications Child is Currently Taking
  
  Allergies/Other Medical Conditions
  
  Family Health Plan Carrier
  
  Family Doctor Name and Phone Number
  
  Emergency Medical Treatment
  In the event of an emergency, I hereby give permission to transport my child to a hospital for emergency medical or surgical treatment. I wish to be advised prior to any further treatment by the hospital or doctor In the event of an emergency if you are unable to reach me at the above numbers, contact:
  
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  Permissions
  Please indicate if you give permission for your child's picture to be used in HFA/HFC photos and videos for our website and printed materials.
  
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  I grant permission for my child to participate in this parish activity. This activity will take place under the guidance and direction of parish employees and/or volunteers from Holy Family Church.
  
  As a parent and/or legal guardian, I remain legally responsible for any personal actions taken by the above-named minor ("participant"). I agree on behalf of myself, my child named herein, or our heirs, successors, and assigns, to hold harmless and defend Holy Family Church, its officers, directors and agents, and the Archdiocese of Saint Paul and Minneapolis, coaches, chaperones, or representatives associated with the activity for reasonable attorney's fees and expenses arising in connection therewith.
  
  By submitting this form, you acknowledge that you have read and understood the agreement and agree to all its terms and conditions.
  
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Chess Club Registration

Further Information (if applicable)The remainder of this form only needs to be filled out for child registrants.

Parent/Guardian Information

Medical Information

Permissions

Please indicate if you give permission for your child's picture to be used in HFA/HFC photos and videos for our website and printed materials.

Further Information (if applicable)
The remainder of this form only needs to be filled out for child registrants.