2021 Winter Kids Club - Chess $19 payment

Child's Name*
First Last
Child's Classroom Teacher or Class #*
Child's Cohort*
Parent/Guardian Name*
First Last
Parent/Guardian Email*
Parent/Guardian Phone*
Parent/Guardian #2 Name
First Last
Please only fill out if the second parent/guardian needs to be informed about Kid's Club updates.
Parent/Guardian #2 Email
Parent/Guardian #2 Phone
Winter 2021 - Kid's Club - Thurs. Chess (2&3) $19 payment*
Price: $19.00
Total
$0.00
Credit Card*

American Express
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MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name