Chess-Bee Academy | Herndon Elementary PTA

Student Name*

First Last

Grade*

Teacher*

Parent Name*

First Last

Phone

Email

Does your child attend SACC*

Allergies or Special Conditions

Chess Bee Academy

Price:

Scholarship Fund Donation

The scholarship fund allows other HES students the opportunity to experience the benefits of PTA-sponsored clubs and activities.

Register another student for this club?*

Student Name*

First Last

Grade*

Teacher*

Does your child attend SACC*

Allergies or Special Conditions

Chess Bee Academy*

Price:

Waiver*

I realize that participation in before and after school activities may involve risk. I give my consent for my child to participate in these activities and I assume the risk. I authorize the instructor is act for me according to his/her best judgment to administer or procure medical attention for my child if s/he is injured while participating in these activities. I understand all personal absences are forfeited. Any classes missed due to school closing will be rescheduled or reimbursed.

Total

$0.00

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name