2021 Winter Kids Club - Chess $19 payment Child's Name* First Last Child's Classroom Teacher or Class #*Child's Cohort*ABDParent/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 PhoneWinter 2021 - Kid's Club - Thurs. Chess (2&3) $19 payment* Price: $19.00 Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name