9TH ANNUAL MID-SOUTH CHESS SUMMER CAMP IN MEMPHIS

CAMPER'S REGISTRATION FORM

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5 day camp*          Commuter lunch**       Residential housing and meals***

Evening activities for commuter students****         Precare*****       Aftercare*****

Assumption of risk and release of liability: The undersigned parent, guardian, or adult in consideration of participating in Mid-South Chess Camp agrees to hold harm less said Camp and its representatives and releases same from any and all liability for any injury suffered by the participant 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 attached completed medical form to registration form

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*SPECTACULAR 5 DAY CAMP: Mon - Thur 10 am - 4 pm and Fri 10 am - 5 pm. TUITION: $350 before March 15; $375 March 15 - May 15; $425 after May 15. A $100 non-refundable deposit will hold a spot for you. REGISTRATION INCLUDES: camp T-shirt, daily souvenirs, camp photo (group), trophy, autographed certificate, and entry to a USCF tournament. **COMMUTER LUNCH: $35/week. ***RESIDENTIAL CAMPERS: $225 additional breakfast, lunch and dinner daily, in-home hospitality in other campers family homes in Memphis, transportation to and from camp and airport and evening chess activities. NOTE: add $25 for supervised lodging in a nearby residential hotel. ****COMMUTER CAMPERS: $100 additional for extended activities after regular camp hours Monday - Thursday evening 4-6:30 pm includes dinner, fun chess activities, and sports. *****PRECARE and AFTERCARE: precare (nonominal fee) begins at 7:30 am, aftercare (nominal fee) 4-6 pm please call Arlene at 901-276-4663 for more info or email midsouthchess@hotmail.com Mail completed registration and medical forms with check payable to: Mid-South Chess, 1614 Vance Ave, Memphis, TN 38104 Questions: (901)276 4663