Registration Form
WooHoo! Your child is about to have a blast at our Award-Winning Program. Please fill-in this Registration Form and submit before class.
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Child's Name: *
Date of Birth: *
Sibling Name(s):
Date of Birth(s):
Street Address: *
Address line 2:
City: *
State: *
Postal / Zip Code: *
Country: *
School: *
Phone: *
E-mail: *
Chess Experience (if any): *
Allergies (if any): *
Referred By (if any):
How did you hear about us?:
 *
Anything else you would like us to know about your child?
Vellotti's Chess School Medical & Emergency Services Release Forms / Medical Release The classes/camps will attempt to accommodate all participants. However, resources are not unlimited, so such accommodations, though desirable, may not be possible. This is also true of dealing with specific dietary allergies, e.g., exposure to foodstuffs including peanuts or peanut derivatives. If the prospective participant is considered to have special needs, or has significant allergies or other medical/dietary needs, these particulars must be disclosed and discussed before a reservation is accepted. This is for the benefit of the child, the other participants, and the staff of Vellotti's Chess School. Please disclose all special medical, dietary and other concerns of the registrant in the space provided. This information will be reviewed and, if necessary, discussed with you prior to the acceptance of the reservation. As an additional note, all classes and camps are "Drop Off" events and parents must make sure in advance that their child is independent enough and comfortable to be in group classes without their parents/guardians present. *
Required
Emergency Services I, the undersigned parent or legal guardian of the registrant minor, agree to allow Vellotti's staff and chess camp instructors to take what actions are deemed appropriate in emergency situations involving said minor, including the alerting of Emergency Medical Services (EMS). I also accept full financial responsibility for any and all charges for emergency services and for subsequent and consequent care. I do hereby agree to release, discharge, and hold harmless Vellotti's Chess School, the camp staff, and school instructors from all liabilities, damages, claims, or demands whatsoever on account of any injury or accident involving the said minor arising out of the minor's attendance for classes or camps at Vellotti's Chess School or in the course of activities held during the camp. I have read, understand and fully accept the policies set forth by Vellotti's Chess School. *
Required
Photography and Name Release Form I, the undersigned parent or legal guardian of the registrant minor, agree to allow Vellotti's Chess School staff and chess camp instructors to use said minor’s name and/or image for advertising, news and awards purposes. *
Required
Vellotti's Chess School Rules Agreement Form and Disciplinary Policy The primary goal of the classes/camps is to provide chess instruction and fun experiences to all the participants. If one or more participants interfere significantly with this process, then it is deemed as detrimental to the group as a whole and will not be tolerated. We have developed a number of skills to guide occasional and insignificant offenders back into the process, but we are not equipped, nor required by circumstances, to deal with continued and repeated disruptions, and certainly not any involving bodily injury to anyone present, or physical damage to the premises or any of its contents. Students should expect a “total immersion” chess experience and to gain knowledge with respect to their abilities and maturity. Knowing this, the parent(s) or legal guardian(s) responsible for registering the participant should consider whether or not these rules fit the minor’s personality and expectations. I, the undersigned parent or legal guardian of the subject minor, agree to allow Vellotti's Chess School staff and chess camp instructors, to use appropriate disciplinary measures in dealing with said minor. Appropriate measures: • First offense – a behavioral warning will be issued to the minor. • Second offense – direct discussion with the undersigned parent/guardian • Third offense – dismissal of the minor from the class/camp, to be facilitated by the prompt removal of the minor from the premises by the undersigned. • ANY significant acts of physical or emotional aggression to others, or acts causing property damage, may result in the participant’s immediate dismissal and prompt removal by the undersigned. Note: There will be no refunds in the case of any disciplinary dismissals! *
Required
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