Chess Citizenship Academy Application
We are so excited that you are interested in participating in our 2021 ROI Chess Citizenship Academy!

Dates: 8 Consecutive Saturdays from 11am - 2pm from February 6th - March 27th

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

COVID-19 Protocols will be observed.

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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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Phone Number *
Emergency Contact First Name *
Emergency Contact Last Name *
Emergency Contact Phone Number *
Emergency Contact Email Address *
Are you available to meet for 8 consecutive Saturdays from 11am-2pm, February 6th-March 27th? *
Are you familiar with the basic rules of chess? *
Have you ever played in a chess tournament? *
Why do you want to participate in the 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.
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. *
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