California Youth Chess League Online Registration

Registration

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Hello! Welcome to CYCL's online registration for chess classes! It might take a little longer this first time, but will make things much easier in the future! FOR LOCATION: Select CYCL Please NOTE: Our credit card processing has changed, please do not input your credit card as it will not work or be charged through Jackrabbit. Thank you!

* denotes required fields

Referral Information

How did you hear about us?*

Referral Name*

Family Information

Family Last Name*

Where do you live?

Home Address*

City*

State*

Zip*

Home or Primary Phone*

Additional Info

Emergency Contact Info

Health Insurance Carrier

Contact #1

Parent/Guardian # 1 First Name*

Last Name *

Type*

How Can We Contact You?

Home Phone *

Work #

Cell #

Portal Access (your email is your login)

Email* (Emails are kept confidential)

Confirm Email*

Portal Account Password

Confirm Portal Account Password

Who is your employer?

Employer

Employer Phone

Employer Notes

Contact #2

Parent/Guardian # 2 First Name

Last Name

Type

How can we contact you?

Home Phone

Work #

Cell #

Email (Emails are kept confidential)

Confirm Email

Who is your employer?

Employer

Employer Phone

Employer Notes

Student #1

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade Level*

Pick-up, Walk, or Day Care?*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

School Teacher*

Please double check that you put your child in the correct class! If you have a second child you would like to enroll, make sure you put them in the second sibling class to receive the sibling discount.

Enroll in Classes

Select Class *

Student #2 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade Level*

Pick-up, Walk, or Day Care?*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

School Teacher*

Enroll in Classes

Select Class

Student #3 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade Level*

Pick-up, Walk, or Day Care?*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

School Teacher*

Enroll in Classes

Select Class

Student #4 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade Level*

Pick-up, Walk, or Day Care?*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

School Teacher*

Enroll in Classes

Select Class

Student #5 (Show-Hide Details)

Student's First Name*

Last Name*

Student Gender*

Birth Date* (format=mm/dd/yyyy)

Additional Info

Student Email

School*

Grade Level*

Pick-up, Walk, or Day Care?*

Disabilities (Leave blank if NONE)

Special Needs (Leave blank if NONE)

Allergies (Leave blank if NONE)

School Teacher*

Enroll in Classes

Select Class

Add Another Student

Required Policies and Agreements

Contact if not attending

If your child will not be attending chess (after attending school that day) for any reason, please make every effort to contact us so we do not search the school for your child. CYCL 661-288-1705.

I've read the above and agree.

Running late?

If you are running late, please know that we often go from one school directly to another. If we do not leave in time, there could be a classroom of unattended children waiting for us. Please make every effort to arrive on time, or contact the school in case an emergency prevents you from doing so.

I've read the above and agree.

Payment Policies

You can get a refund for classes not yet attended (not past classes that were attended or not) upon request. Please give us a week or so to get the check to you. Email your refund request to coachjay@cycl.org.

I've read the above and agree.

Medical Emergencies

By checking here, you give us permission to seek medical attention for your child if the situation requires it. Our coaches will simultaneously call 911 and your cell phone (priority to 911) in the case of a serious injury. In 15 years of over 20,000 students, we have not had to make this call, but we are always prepared to do so if necessary.

I've read the above and agree.

I Agree to All of the Above

Enter your Full Name*

Questions or Concerns

Comments