<b>Student's Full Name:</b> *

<b>Student's Age</b> *

<b>Student's Grade</b> *Please select an option—12345678

<b>Current USCF Rating (if any)</b> *

<b>Parent's Email Address</b> *

<b>Phone Number</b>Your number will be used to communicate with you regarding your lessons *

<b>State</b> *Please select an optionAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming—District of ColumbiaPuerto RicoGuamAmerican SamoaU.S. Virgin IslandsNorthern Mariana Islands

<b>Select your Private Lessons Package</b> *Please select an optionSelect a Option1 Lesson4 Lessons16 Lessons

<b>Are you enrolling another student</b>YesNo

<b>Child's Name</b> *

<b>Child's Age</b> *

<b>Child's Grade</b> *Please select an option—12345678

<b>Child's Current USCF Rating (if any)</b> *

<b>Select your Child's Private Lessons Package</b> *Please select an optionSelect a Option1 Lesson4 Lessons16 Lessons

<b>Additional Comments (If any)</b>Ex. Siblings/Referrals, etc.

<b>How did you hear about ThinkChess?</b>Google SearchSocial MediaSchool PTOReferral

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<b>Parent's Signature</b>Your Full Name *

Total Fees:<b class="price"> *

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