MID-SOUTH CHESS CAMP IN MEMPHIS
CAMPER'S REGISTRATION FORM
 
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5 day camp Commuter lunch Residential (Homewood Suites) 5 nights June 11-15
Evening activities for commuter students Precare      Aftercare Residential (Homewood Suites) June 11-16
 
          Assumption of risk and release of liability: The undersigned parent, guardian, or adult in consideration of camper participating in the 2017 Mid-South Chess Camp agrees to hold harmless said Camp and its representatives and employees and releases same from any and all liability for any injury suffered by the camper named herein, arising or connected with said Camp and parent, guardian, or adult assumes all risk of any injury.
 
Date:           Signature: ______________________________
                                                                Camper/Parent or Guardian of Camper
 
PLEASE PRINT AND MAIL COMPLETED REGISTRATION FORM, MEDICAL FORM, AND CHECK PAYABLE TO:
MID-SOUTH CHESS
1614 VANCE AVE.
MEMPHIS, TN 38104
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TUITION:      $395 Early Bird by April 15th;      $425 by May 10th;      $450 after May 10th;      $475 at the door(Limited space).
DEPOSIT:      A $100.00 deposit holds your spot and is applied to tuition.
TUITION INCLUDES:      Camp T-Shirt, Trophy, Group Photo, Autographed Certificate, Daily Souvenir, Gradmaster Simul (June 13),
Game night (June 15) and Entry to the rated or unrated Scholastic Section of our June 16th Open & Scholastic Tournament.
COMMUTER LUNCH (5 days):      $35 (payable to Lausanne School).
RESIDENTIAL CAMPERS:      Residential fee includes all lodging, all meals, transportation, evening activities with our titled coaches
including bowling, putt-putt, grandmaster simul, and game night plus lodging at Homewood Suites 7855 Wolf River Blvd,
5 nights, 1 seasoned counselor to 3-4 campers per suite, Residential fee $395; for Friday night stay (6 nights) add $50.00.
COMMUTER CAMPERS:      Evening activities with our titled players. Pay as you go for bowling and putt-putt.
PRECARE/AFTERCARE:      Call (901) 276 4663 or email midsouthchess@hotmail.com for more information.
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CONTACT INFORMATION:
Arlene Kleiman, Director, or International Master Jake Kleiman
Call: (901) 276 4663 or
Email: midsouthchess@hotmail.com