Chess Citizenship Academy Application
We are so excited that you are interested in participating in our 2022 ROI Chess Citizenship Academy! This experience intends to educate and empower youth in grades 7-10 to start their own chess clubs and to use the wisdom of chess to influence the culture of their communities. This is a space for youth that want to take chess in Columbus to the next level while growing as leaders.

Dates: 11 Consecutive Saturdays from 11am - 2pm from January 22 - April 2

We will host an informational and open house on Saturday, January 15 from 11:00am-1:00pm.

The graduation and celebration will take place on Saturday, April 2.

Location: St. Stephens Community House | 1500 E. 17th Ave, Columbus, OH 43219

COVID-19 Protocols will be observed.

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Email *
Youth first name *
Youth last name *
Youth's email *
Zip code *
School *
What grade are you currently in? *
Date of Birth *
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Youth Phone Number *
Youth Phone Type *
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Phone Number *
Emergency Contact Email Address *
Are you available to meet for 11 consecutive Saturdays from 11am-2pm, January 22-April 2? *
Are you familiar with the basic rules of chess? *
Do you already have an online chess account on any of the following websites?
Have you ever played in a chess tournament? *
Do you currently participate in a chess club? *
If you could start a chess club in your community, where would it be? (Ex. School, library, recreation center, etc.)
Do you have a rating with the United States Chess Federation?
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Why do you want to participate in the Royal Oak Chess Citizenship Academy? *
What is En Passant?
If you could be any chess piece, what would you be and why? *
Answer as thoroughly as you'd like.
Do you have any allergies or dietary restrictions? *
What size t-shirt do you wear (adult sizes)? *
Media & Photo Release: I grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or video tape without payment or any other consideration.  I understand that my image may be edited, copied, exhibited, published, or distributed and waive the right to inspect or approve the finished product wherein my likeness appears.  I understand this permission signifies that photographic or video recordings of me may be electronically displayed via the internet or in the public educational and marketing settings. I release and discharge Royal Oak Initiative their officers, associates and directors from any claim, action suit or demand of any kind including but not limited to, invasion of privacy, rights of publicity, or claims resulting from any blurring, distorting, alteration, or use in composite form that may occur or be produced in the reproduction, use, processing, printing or publication of the photographs. There is no time limit on the validity of this release, nor is there any geographic limitation on where these materials may be distributed.  This release applies to photographic, audio, and video recording collected as part of this event. *
A copy of your responses will be emailed to the address you provided.
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