2022-2023 Wed. Chess Teams Payment Page

Kid's Club "Chess Teams with Nick"

Child's Name(Required)

First Last

Child's Classroom Teacher/Class #(Required)

Parent/Guardian A Name(Required)

First Last

Parent/Guardian A Email(Required)

Enter Email Confirm Email

Parent/Guardian A Phone(Required)

Parent/Guardian B Name

First Last

Please only fill out if second parent/guardian needs to know about Kid's Club

Parent/Guardian B Email

Enter Email Confirm Email

Parent/Guardian B Phone

Kid's Club Chess Teams(Required)

Price:

Total

Payment Method*

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

School Number: 15K321

Lower School: 763 President St., Brooklyn, NY 11215 – Phone: (929) 992-8578

Upper School: 180 7th Ave, Brooklyn, NY 11215 – Phone: (718) 499-2412