Age Date-of-Birth Grade School Previous Chess Odyssey Programs? US Chess Federation member? Rating? Medical or Other Issues? For which camps are you registering? June 15-19 (NW Portland) June 22-26 (NW Portland) July 20-24 (Beaverton) August 3-7 (NW Portland) August 17-21 (NW Portland) Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton) Parent email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Grade School Previous Chess Odyssey Programs? US Chess Federation member? Rating? Medical or Other Issues? For which camps are you registering? June 15-19 (NW Portland) June 22-26 (NW Portland) July 20-24 (Beaverton) August 3-7 (NW Portland) August 17-21 (NW Portland) Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton) Parent email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Previous Chess Odyssey Programs? US Chess Federation member? Rating? Medical or Other Issues? For which camps are you registering? June 15-19 (NW Portland) June 22-26 (NW Portland) July 20-24 (Beaverton) August 3-7 (NW Portland) August 17-21 (NW Portland) Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton) Parent email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
US Chess Federation member? Rating? Medical or Other Issues? For which camps are you registering? June 15-19 (NW Portland) June 22-26 (NW Portland) July 20-24 (Beaverton) August 3-7 (NW Portland) August 17-21 (NW Portland) Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton) Parent email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Medical or Other Issues? For which camps are you registering? June 15-19 (NW Portland) June 22-26 (NW Portland) July 20-24 (Beaverton) August 3-7 (NW Portland) August 17-21 (NW Portland) Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton) Parent email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
For which camps are you registering?
Please consider me for an invitation to The Intensive Seminar July 6-10 (Beaverton)
Parent
email Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Street City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
City State ZIP Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Home phone Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Cell Phone Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Emergency Contact Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Relationship Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Phone Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.
Medical Consent and Release of Liablility In consideration of participation in this Chess Odyssey event, participants acknowledge that they are aware of the nature of the activity, and that there are inherent risks in any such activity, and release Chess Odyssey and Evergreen Presbyterian Church from any and all claims for personal injuries. Participants and/or parent/guardian of a registered minor authorize employees of Chess Odyssey to seek medical treatment in the event of a n accident or emergency. Photos taken during programs may be used for promotional purposes. Payment of fee and participation in the program constitute acceptance of this liability, medical, and photography release.