First Lutheran Church: 1300 E. Colorado St. Glendale, CA 91205 MAY 30 , 2015 SCHOLASTIC CHESS CHAMPIONSHIP Sections: TH 50 TROPHIES & OTHER PRIZES WILL BE AWARDED K-6 Unrated K-5 U500 K-8 U900 K-12 OPEN kK Early Registration: $30 due on or before May 20th, 2015. No Telephone Entries Later registration: $40 due at the site between 9-9:45am ONLY. After 9:45am, ½ point bye will be given for the 1st round. Signed registration forms must accompany the registration fee. New players to the U. S. Chess Federation (or those whose memberships have expired) must also pay the annual membership fee by visiting https://secure2.uschess.org/webstore/member.php, or pay for their memberships on site. Section (Circle One) K-6 Unr K-5 U500 K-8 U900 K-12 OPEN ROUND TIMES 10:00am 11:15am 12:30pm 1:45pm 3:00pm 5SS (Swiss System: everyone plays 5 games against players with approximately the same number of wins and losses after each round), Participant’s Name:__________________________________________ Date of Birth:_______________USCF ID:______________ Exp:______ School/ Chess Club:__________________________Grade__________ Address:__________________________________________________ Email________________________________ Phone_______________ Parent’s Signature:__________________________________________ G/30 (Timers may be used which limit the total game time for each player to 30 minutes) AAA CHESS CLUB 5317 Virginia Ave. Los Angeles, CA 90029 www.aaachessclub.com I request that my child, named above, be permitted to participate in the above chess event. I fully understand my representative or I will take full responsibility for supervising my child during this event. Should it be necessary for my child to have medical treatment while participating in this event, I hereby give the supervisory personnel to use their judgment in obtaining medical service for my child and I further give permission to the physician selected by such personnel to render medical treatment deemed necessary and appropriate by the physician. I, as parent or representative of this child, hereby release, discharge, indemnify and hold harmless AAA Chess Club, the First Lutheran Church, employees, volunteers, and/or board of directors from any claims arising out of or relating to any injury that may result to said individual while participating in this event Nshan Keshishian C: 323.578.8424 E: [email protected] Please make all checks payable to: AAA Chess Club