<p>Membership Form Club Administration Use Only Dues Received m/d/y Crosby High Chess Club Cash $10.00 _____ or Return this form with $10 dues to the Crosby High Chess Club Check Number ______Sponsor at a Thursday meeting immediately after school in Crosby High School room 715, starting Sept. 4, 2008. Name (First, MI, “Nick” & Last): Grade: Date of Birth: m/d/y Gender Homeroom Teacher: Have you been a member of a chess club before? If yes, for how many years? Where? Do you have a National USCF Chess Rating? If yes, what’s your USCF rating? ID #? Exp Date? Please circle your estimated skill level: Beginner: You don’t know how to move the pieces. (lessons will start with the basics) Advanced Beginner: You know how to move & capture the pieces. Intermediate: You’ve played in a club & understand the rules of en passant & castling. Advanced: You’ve played in tournaments or have been an active member of a Chess Club/Team.</p><p>Parental Approval (required before first meeting): Parents’ Names: Name of person to ask for when calling numbers below: Home Phone: Work Phone: Cell Phone Email Address: Emergency contact Name & Number: Are you interested in volunteering to help with chess club meetings and activities? If your child will be walking home, please sign here By signing below I confirm understanding of the following: The Crosby High Chess Club will meet weekly Thursdays after school until 3:30 pm in room 715. Parents MUST arrange transportation for their child PROMPTLY at 3:30 after meetings. Chess club members will exit the school after meetings from the north entrance (senior parking lot). This completed and signed form with a $10 annual dues must be received at the 1st meeting attended. Cash or checks payable to Crosby High School should be attached to this form when submitted. Chess sets and clocks are provided by the Chess Club during club meetings & must remain at school. Parents are responsible for replacement cost of any club equipment damaged or lost by their child. Images of your child with their name may appear in news coverage of Crosby High Chess Club activities. Membership may be revoked without fee reimbursement for misbehavior or violation of club rules.</p><p>Parent Signature Date m/d/y For more information, please contact Miss Rodriguez – [email protected] 281-462-3148</p>