Registration

Polk Scholastic Chess
P. O. Box 252
Bartow, FL. 33831 - 0252

Annual Membership Registration Form for 2022 - 2023 Tournament Season

Entry fees $35.00 per student. Application deadline Sept 20, 2022. Any applications received after Sept 20 will need to be submitted with a $10.00 late fee (Total $45.00). Last date for registration with late fees is Oct 1, 2022.

Player Information

Player Name: (enter name as registered in school) *

Date Of Birth: *

Gender: *

Male

Female

Prefer not to disclose

Parent/Guardian Name:

Contact Information

Address:

Address 2:

City: *

State: *

Zip Code: *

Phone No. *

Email: *

Emergency Contact: *

Emergency Phone: *

School Information

Name Of School: *

Grade: *

Member Of School Team

Online Signature: * (Enter your initials (e.g. RF ) in agreement to our Terms and Conditions on this website and our tournament rules. Link to our website's Terms and Conditions is available at the bottom of this page.)

Payment Information

Registration fees: *

Payment: *

NOTE: We use the secure payment gateway from PayPal. Your sensitive information is not saved on our servers and we do not share your information with third party marketing companies.

Participation Agreement:

Polk Scholastic Chess is an invitational extracurricular program for the Polk County Schools. All participants (players, coaches, and parents) are subject to the rules and regulations of the School Board of Polk County Schools, and Polk Scholastic Chess, which includes the Code of Conduct and the Volunteers in Polk (VIP) program.

Parents are responsible to ensure that their student(s) are properly supervised during the tournaments. The supervision can be provided by a PSC-approved coach.

NOTE:

Students that are not properly supervised (all day) will not be allowed to compete in PSC tournaments or rounds. All membership and tournament fees are non-refundable and will be considered a donation to Polk Scholastic Chess if you decide you don’t want to play in all of the tournaments. Please read the Polk Scholastic Chess “Coaches’ and Players’ Manual,” which can be found on the web site at www.polkscholasticchess.com. We will be posting the results of the tournaments on this website and you have provided your consent to display the name of your child and his/her scores. We will be photographing and utilizing students names for public relations purposes and to publish on to our site at www.polkscholasticchess.com. Providing incorrect information to us could disqualify the player and/or school. There will be a $10.00 service fee for All RETURNED CHECKS.

By clicking on the Submit botton, you agree that you have read the Polk Scholastic Chess “Coaches’ and Players’ Manual,” and agreed to our terms and conditions by providing your initials on this registration form. You also agree that PSC will not be held responsible for lost articles, injuries, medical issues, etc. to you or your children while at our tournaments.

Thank you

Board Members
Polk Scholastic Chess

POLK SCHOLASTIC CHESS is a non-profit, 501(c) 3 organization dedicated to “Encourage Academic Growth Through the Game of Chess ”

For technical problems on this website or with this email, please email us at webmaster@polkscholasticchess.com

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"Encouraging academic growth through the game of chess"... ...since over 30 years

A non-profit 501(c)(3) organization established in the State of Florida

Player Information

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School Information

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