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Manitoba Chess Association

Jr. Chess Camp

August 5-8, 2014 University of Winnipeg

Manitoba Chess Association:Junior Chessc/o 501 Waterloo Street Winnipeg, MB R3N 0S9EMAIL: manitobajrchess@gmail.com

REGISTRATION:I am registering for: Intermediate Chess Camp $175.00

Beginner Chess Camp $ 90.00

Important Information:

Name:______________________________

Address:____________________________

Phone:______________________________

Email:_______________________________

Parent/Guardian:_______________________

Registration forms will be processed in the order they are received. We cannot hold spots. One application per child

All applications must include the release section (other side of registration) signed and payment before they will be processed. Registration deadline is July 9th. Applications received after this date are subject to availability of space.

Please make cheques payable to the Manitoba Chess Association and write the child’s name on the back of the cheque or money order A $30 charge will be applied to all returned cheques.

Refunds:

Full refunds will be issued if we cancel a program prior to the start date. If a program is cancelled after the start date, the registrant will receive credit for the value of the program.

If a registrant withdraws from a program 10 or more days before the start date they may receive a refund of program amount less a $20 processing fee. If a registrant withdraws from a program less than 10 days before the start date they may receive a credit for the value of the program less a $20 processing fee.

Credits are valid for one year from date of issue. Credits can be trans-ferred among immediate family members and are not redeemable for cash.

No refunds will be issued when a registrant has been asked to leave a program.

Manitoba Chess AssociationJunior Chess Camp

Tuesday August 5 - Friday August 8, 9:30-3:30

Do you know what Kobe Bryant, Dominic Haseck, Anna Kournikova, Will Smith, Jay Z, Bill Gates, Jude Law, Ben Affleck, Christina Ricci, Salma Hayek and Carmen Kass have in

common?

They all play chess.

Manitoba Chess Association – Junior Chess Camp wants to meet the future stars to rock the boards in the province this summer.

Open to all junior chess players under the age of 19

Intermediate (all day) - $175Throughout the week chess is presented in many different ways to enhance the participants

understanding and enjoyment of the game. Activities include classroom instruction, tournaments , simultaneous exhibitions, bughouse, giveaway chess, blitz tournaments, chess

lectures.Players should have some experience playing organized tournaments

Beginner (morning only) - $90For participants with little or no chess experience to come and learn the moves and basic

strategy.

Limited seating available for each section. Be sure to register early. Special pricing for siblings. Ask for details.

Instructor: Dave Ross, IM (International Master)

Chess has many benefits, improving math, reading, overall academic performance, creative and critical thinking, memory, verbal reasoning, concentration, and most of all self esteem.

Visit http://www.psmcd.net/otherfiles/BenefitsOfChessInEdScreen2.pdf for a collection of case studies on the benefits of chess

Manitoba Chess Association Junior Chess Camp ReleaseManitoba Health Number:_____________________PHIN:__________________________________Emergency Contact:________________________Known Medical Conditions:______________________________________May be picked up by: Mother Father Other_______(Pick up by anyone not listed on this form will require notification and for identification to be provided)

Consent and Release Personal/PropertyIn consideration of the child named on this form (“Participant”) being allowed to participate in Manitoba Chess Association – Junior Chess Camp (MCA-JCC), the Participant and parent and/or guardian, hereby releases the Manitoba Chess Association, and its governors, officers, volunteers, representatives and agents from and against all claims, actions, demands, costs and expenses relating to injury, damage to person or property or loss of property, howsoever caused, arising out of or in connection with participation in MCA-JCC. This release shall be binding upon the Participant, the undersigned and the estates of the Participant and the undersigned.

Transportation Consent I hereby authorize the transportation of Participant to and from all field trips, activities, and locations MCA-JCC deems reasonable each day.

Photographic Consent I hereby give permission to MCA-JCC to photograph Participant in a reason-able and professional manner for promotional and advertising purposes (i.e. camp videos, scrapbooks, brochures, picture day, etc.)

Emergency Medical Consent I hereby authorize the procurement of whatever emergency medical treatment may be necessary for Participant. I also authorize the removal of Participant from Camp premises for the purpose of obtaining such emergency medical treatment if the need so arises. I agree to hold MCA-JCC harmless for the nature, performance, and outcome of any such emergency medical treatment and that the determination of whether an emergency has arisen shall be left to the sole discretion of MCA-JCC.

Personal Information Consent for the Storage of Personal Information: I give permission to the MCA-JCC to collect the information provided for the following purposes: (i) process the program application; (ii) provide the services contemplated by the program; (iii) contact you with information on future programs offered by the MCA-JCC and (iv) statistical purposes. I give my consent for the storage of personal information on the basis that this information will be used internally by the MCA-JCC only and will not be shared with any third party.

MY SIGNATURE BELOW INDICATES THAT I HAVE READ THIS ENTIRE DOCUMENT, FULLY UNDERSTAND ITS TERMS, UN-DERSTAND THAT IT AFFECTS MY LEGAL RIGHTS, AND AGREE TO BE BOUND BY ITS TERMS.

______________________________________Parent/Guardian Signature