Student Name(First and Last)* Note: This is how it will be displayed and shown. *

Student Email (Optional)

Student Has Scholastic Chess Membership No Yes

School * -- Select School -- Prairie Creek Prairie Crest Prairie Heights Prairie Hill Prairie Ridge Prairie View Prairie Point

Grade * -- Select Grade -- 2 3 4 5 6 7 8

1st Parent/Guardian Name *

1st Parent/Guardian Email *

1st Parent/Guardian Phone *

2nd Parent/Guardian Name (Optional)

2nd Parent/Guardian Email (Optional)

2nd Parent/Guardian Phone (Optional)

Additional Information