FAIR LAWN REGISTRATION FORM
Child #1
Firs Name
Last Name
DOB
Child #2
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#

Day Of Class:
TUESDAY (Fair Lawn) THURSDAY (Fair Lawn) SATURDAY (Fair Lawn)

Level of Class (please circle):
BEGINNER INTERMEDIATE 1 INTERMEDIATE 2 ADVANCED

Tuition (please circle): 1 hour/week 1.5 hour/week 2 hours/week 3 hours/week
1st child $242 $363 $440 $520
2nd child $200 $300 $360 $400
Tuition is based on 11 classes
Add $50 registration fee to tuition if registering after February 18.

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