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THIRD ANNUAL CHESS CAMP

JULY 13 – 18, 2003

REGISTRATION FORM

Name

School

Grade Age

Home Address City

State Zip

Phone -

E-mail

USCF ID (not required)

USCF or KSCA Rating (not required)

Registration fees:

Registration deposit – $80 (due by June 15, 2003)

Resident Camper amount

Commuter Camper amount

Insurance Company for injury coverage

Insurance Policy

I hereby authorize the staff of the Lindsborg Chess Camp to act for me according to their best judgement in any emergency requiring medical attention and I hereby waive and release the camp from any and all liability for any injuries or illnesses incurred while at camp. I understand that violation of camp rules may result in dismissal from camp with all tuition forfeited. My signature also indicates that medical permission has been secured to practice and I have insurance to cover any injuries or illnesses incurred during the camp

Parent or Guardian’s Name

For information please e-mail at intecsus@yahoo.com

Please send the registration form and payment to:

 

IntECS, Inc.

232 N. Main Street

Lindsborg, KS 67456

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