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LEE CHESS CLUB
2005-2006 Registration and Waiver Form
* Chess Club Chairs agree to
provide instruction and supervision to all club members while in their
care. Parent volunteers will also assist. All chess boards/pieces
will be provided.
* All Chess Club members will remain in the Lee Library during the
hours the program is offered, except to use the rest-room, get a drink
of water, or be released to their parent/guardian.
* There will be no AISD personnel present to supervise the club members.
* AISD will not be liable for any harm that may occur to club members
or others associated with or participating in the Chess Club.
* Parents/guardians of club members hold AISD, Lee PTA, Chess Club
Chairs and parent volunteers harmless in the event of injury to their
child and will assume responsibility for damage to property caused
by their child. Children must follow all Chess Club rules AND Lee
Library rules while in Chess Club.
* Lee PTA General Liability Insurance provides protection for injury
to club members or damage to property at Lee PTA Chess Club meetings,
to the extent allowable by the policy (created specifically for local
PTAs). Agent: AIM/Association Insurance Management, Inc., PO Box 74296,
Dallas, TX 75374-2946 (1-800-876-4044). Policy limit $1,000,000 for
property damage and personal liability/injury; no deductible.
* Chess Club dues are $12.00/year, per club member. (Please make checks
payable to "Lee PTA".)
Name, grade and homeroom teacher
of Chess Club member(s):
_______________________________________________________________________
_______________________________________________________________________
Check a box:
 My
child is in childcare after school at Lee and I allow my child to be
released to and from childcare to participate in Lee Chess Club.
My
child is in afterschool care at _____________________ and I allow my
child to be released to participate in Lee Chess Club. I will pick up
my child no later than 3:45pm.
My
child is not in childcare after school and I agree to pick up my child
no later than 3:45pm.
My
child is not in childcare and may be released from Chess Club to go
home on his/her own.
Note: Children in childcare at
Lee should report as usual to the cafeteria after school. Chess Club
volunteers will sign them out of childcare soon after, and then bring
them back into childcare at 3:45pm. Parents of children in childcare
at other centers MUST communicate with those centers about their child's
participation in Chess Club. Chess Club will not be responsible for
signing those children out. Children not in childcare may report to
the Library directly after school.
As a parent/guardian of a Lee PTA
Chess Club member, I/we understand and accept the guidelines and responsibilities,
outlined above and on the Lee Chess Club Web Pages.
Name of parent/guardian(s)/signature/date
_______________________________________________________________________
_______________________________________________________________________
Address: ________________________________________________________________
Phone (home, and during Chess Club
hours):______________________________________
Email: __________________________________________________________________
*****Important***** Most Chess
Club communications will be sent by email. Please make a special note
of the best way to contact you if you do not have regular email.
Parent volunteers are needed every
week to help supervise and sign-in/sign-out children (or coach chess,
if they are knowledgeable).
Please
contact me about being a parent volunteer
Dietary Concerns:_________________________________________________________
For students:
I have read and will follow
club rules, library rules and chess rules. I will practice being
a good sport while in Chess Club. I will treat other members, parents
and teachers with respect. I will not only try to have fun in Chess
Club, I will also push myself to learn more about the game so that
I may become a stronger chess player each week.
Member(s) signature:_____________________________________________________
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