|

After the online registration is completed, please mail this form and $50 payable to Chess Adventure to:
Albert Rine Chess Adventure Coordinator 5305 E. 4th Terrace Tulsa, OK 74112
Release Form For: Student’s name (First Last) ___________________________________________________________________________
In consideration of being allowed to participate in Chess Adventure meeting at Rejoice Christian School, Owasso:
I. I acknowledge that there are risks inherent in any activity including playing chess. I hereby agree to assume all of those risks.
II. I agree to hold Rejoice Christian School, their employees, or any persons acting on their behalf, harmless for any accident or injuries that may occur while I am on church or school property. I further agree to hold Rejoice Christian School harmless for any loss or damage to property that may occur while I am on church or school property.
III. I agree to hold Chess Adventure, its coordinators, or any persons acting on their behalf harmless for any accident or injuries that may occur while I am on church or school property. I further agree to hold Chess Adventure harmless for any loss or damage to property that may occur while I am on church or school property.
______________________________________________________________________________________________ Name of Participant (please print) Name of Parent/Guardian (please print)
_______________________________________________________________________________________________ Signature of Parent/Guardian Date
MEDICAL RELEASE
In case of emergency, I give my permission for my child to be treated by the appropriate medical personnel for any illness/accident when I cannot be reached. I understand that I am responsible for any charges resulting from medical treatment.
Parent/Guardian Signature_________________________________________________ Date_____________________
Chess Adventure has been able to keep the camp cost to a minimum because of the tremendous help from the parents. We rely on parents to assist throughout camp. If you are able to help in any way, please let us know!
Times: ____Morning (9:00-12:30) ____Before (12:30-1:00) ____During (1:00-4:30) ____ After (4:30-5:00)
Days: _____Mon _____Tues _____Wed _____ Thurs _____Fri _____Monday setup/registration (10:00-1:00)
I am interested in helping by
_____ Setting up _____ Helping in classrooms (Chess experience is not necessary, but if you have some please let us know!) _____ Cleaning up _____ Registration/check in on Monday _____ Assisting with group activities _____ Helping out in kitchen _____ Anywhere!!!!
Additional Notes:
__________________________________________________________________________________________________________________________________
__________________________________________________________________________________________________________________________________
INDIVIDUAL RELEASE AND HOLD-HARMLESS AGREEMENT
|