The camp fee of $55 ($50 for additional siblings) is payable to Chess Adventure by July 1. You may include it now when mailing this release form or pay at a later date before the July 1 deadline. Refunds will be provided for those who are unable to attend camp due to unforeseen circumstances. To complete the registration and reserve a place for your child at Chess Adventure, please print and complete this form. Then mail it to:

Julie Luscomb
Chess Adventure Coordinator
9502 E. Stone Creek Dr.
Claremore, OK  74017

MEDICAL RELEASE

Release Form For:
Student’s name (First Last) ___________________________________________________________________________

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_____________________

INDIVIDUAL RELEASE AND HOLD-HARMLESS AGREEMENT

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)

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Signature of Parent/Guardian  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)  _____ Weeks before Camp

Days: _____Mon _____Tues _____Wed _____ Thurs _____Fri _____Monday setup/registration (10:00-1:00)

I am interested in helping by
_____ Helping in classrooms (Chess experience is not necessary, but if you have some please let us know!)
_____ Setting up _____ Cleaning up
_____ Registration/check in on Monday              _____ Assisting with group activities
_____ Helping out in kitchen                             _____ Anywhere!!!!

Additional Notes:

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