Diplomat Chess

CHILD NAME

PARENT/GUARDIAN NAME 1

PARENT/GUARDIAN NAME 2

PHONE NUMBER 1

PHONE NUMBER 2

EMAIL

CHILD GRADE Select Grade K 1 2 3 4 5 6 7 8

CHILD'S TEACHER IN SCHOOL

IS THERE ANYTHING ELSE WE SHOULD KNOW? ALLERGIES, SPECIAL NEED, ETC.

PICKUP Select Pickup Parent Pickup Aftercare

Community Park School