DAY CAMP 2008 (Half Day)
Child
Firs Name
Last Name
DOB
School
Grade(s)
Mother's Name
Business phone #
Father's Name
Business phone #
Address
Line 1
Line 2
City
State
Zip
E-mail
Home phone#

USCF rating: (if any) 
Weeks: :
6/307/4; 7/77/11; 7/147/18; 7/217/25; 7/288/1; 8/48/8; 8/11-8/15; 8/18-8/22; 8/25-8/29
Please circle the week(s)
TOTAL ENCLOSED $________


MAKE YOUR CHECK PAYABLE TO:INTERNATIONAL CHESS ACADEMY
Mail to the address:
Diana Tulman 28 Canterbury Lane New Milford NJ 07646