Ed Zelkind Summer Camp Registration Form

Please complete this form and mail it, along with check, to:

Ed Zelkind
1848 Turquoise Trail
Eagan, MN 55122

Indicate week(s) and session (s) your child will attend:

_____ July 21-25 _____ August 4-8

Cost

Full Day 8:30 - 5:00 Full Day 8:30 - 5:00 $297 per week
Morning 8:30 - 12:30 Morning 8:30 - 12:30 $199 per week
Afternoon 1:00 - 5:00 Afternoon 1:00 - 5:00 $199 per week

Camper name: ________________________________ Parent's name: ____________________________________

Address: __________________________________ City: ______________________________ State: ____ Zip: _______

Day Phone: ______________ Evening Phone: _______________ Cell  Phone:______________ Emergency: _____________

Email: _____________________ School: ________________________________________ Grade next year:  _____________

Please list any pre-existing health conditions we should be aware of:_____________________________________________

Skill level:

______ Beginner (Little or no experience)
______ Advanced Beginner (Can checkmate with King & Queen or King & Rook)
______ Intermediate (Has a couple years of tournament experience)
______ Advanced (Has US Chess Federation rating and/or group or private lessons)

T-Shirt Size:

____ Kids 6-8 ____ Kids 8-10 ____ Adult small ____ Adult medium ____ Adult large ____ Adult extra = large