Jasmine Paton Chess Club

Student Full Name

Date of Birth (YYYY-MM-DD)

Gender(required)

Male Female

Student Permanent Street Address and Postcode

Chess Level (required)

Learner (Cannot play independently) Novice Intermediate Advanced

School Name

Member of School Chess Team(required)

Yes No

If you have been referred to Kensal Life, please enter their name here:

Parent / Guardian (1) Name

Parent / Guardian (1) Address – if different to the Child’s

Parent / Guardian (1) Phone Number

Parent / Guardian (1) Email

Parent / Guardian (2) Name

Parent / Guardian (2) Address – if different to the Child’s

Parent / Guardian (2) Phone Number

Parent / Guardian (2) Email

I want to book :(required)

Group- Summer Term- Monday- 16:00 to 16:45 = April (13, 20, 27), May (11,18), June (1, 8, 15, 22, 29), July (6, 13) = £300 Group- Summer Term- Monday- 17:00 to 17:45 = April (13, 20, 27), May (11,18), June (1, 8, 15, 22, 29), July (6, 13) = £300 Group- Summer Term- Tuesday- 16:00 to 16:45= April (14, 21, 28), May (5, 12,19), June (2, 9, 16, 23, 30), July (7, 14)= £325 Group- Summer Term- Tuesday- 17:00 to 17:45= April (14, 21, 28), May (5, 12,19), June (2, 9, 16, 23, 30), July (7, 14) = £325 Group- Summer Term- Wednesday- 16:00 to 16:45= April (15, 22, 29), May (6, 13,20), June (3, 10, 24), July (1, 8, 15) = £300 Group (10+ YEARS) – Summer Term- Wednesday- 17:00 to 17:45 = April (15, 22, 29), May (6, 13,20), June (3, 10, 24), July (1, 8, 15)= £300 1:1 Tuition – In Person – Jasmine Paton – Novice to Advanced [London, UK]

Discounts

Siblings – Sibling is an existing or previous Chess customer

Other Details We Should Know (e.g. Special Educational Needs)

Full Name of Parent / Guardian Completing and Signing the Declaration

Your booking has been received