Prospective School Survey

Student Name *

First Name

Last Name

Has your child ever played chess before? *

Yes

No

Are you willing to pay $120 - $280 for 12 weeks of engaging and concentrated chess instruction for your child? *

Yes

No

Is your child registered & rated with USCF?

Yes

No

Parent Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent Phone

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