The Lincoln/Ravinia/Braeside/Edgewood Chess Club
Scholastic chess has enjoyed explosive growth in recent years and more and more people are
interested in playing! Beyond the sheer pleasure of the game, studies have shown that chess
improves academic performance, concentration, logical thinking, and social skills.
The Lincoln/Ravinia/Braeside/Edgewood Chess Club will hold its first session on Thursday,
September 29, 2016 and end on March 23, 2017, just prior to Spring Break. The club is open
to those in grades K-8 and will meet on Thursday afternoons in the Lincoln lunch room from
3:20 to 4:45pm. We welcome all levels of students to our chess club and encourage you and
your child to visit our club prior to joining. Chess sets and boards are provided by the club.
Chess Club members begin each lesson with a nut-free snack brought from home and play chess
with the other members while waiting for the lessons to begin. We have a short meeting then
break into lessons for about 30 minutes followed by more free chess play.
The club ranks members according to their wins and losses, and the club maintains an incentive
system to reward our members for various activities. We will play matches against other
schools and encourage club members who feel ready to attend local tournaments.
Dues for ALL students are $100 for the entire year—checks can be made out to “Lincoln School
PTA.” Scholarships may be available. Please complete the registration and student information
forms and return them to the Lincoln School office (711 Lincoln Ave. West) or bring it to the
first Chess Club meeting. For additional information, email Maria Lara at
[email protected] or Kristen Abreu at [email protected]. If you plan to join,
please let Maria know by Sept. 22nd so that we can plan for our coaching needs.
If the LRBE chess club meeting time does not fit your schedule, there are other chess clubs in
the district that will welcome you. See www.hpchess.org for more details.
Registration Form 2016-2017
Name of member: _______________________________________
Grade: ________
School: ______________________
Parents’ names: _____________________________________________________
Phone numbers (incl. cell): _______________________________________________________
E-mail address for club notices: ________________________________________
Experience Level (check one):
___ Beginner (does not know how to move the pieces)
___ Intermediate (knows the moves, including en passant and castling, and some strategy)
___ Advanced (comfortable with notation, knows basic principles of strategy, understands idea of
positional chess, has played competitively)
I, ______________________, the parent/guardian of the above student, give my permission for
him/her to attend meetings of the Lincoln Chess Club. I agree to follow the attendance and security
procedures spelled out in the club Handbook.
_____ I am interested in a scholarship.
Parental involvement is encouraged and needed. We benefit especially when parents are able to attend
club meetings whether or not they play chess. Please indicate below how you can help the club.
_____ By attending club meetings
_____ By helping at club or district-wide tournaments
_____ Some other way: __________________________________________
Anything you would like us to know about your child?
______________________________________________________________________
Chess Club Behavior Policy
Members are expected to behave as in any other classroom situation. Children displaying
inappropriate behavior will be asked to leave the program. Inappropriate behavior includes, but is not
limited to, unacceptable language, poor sportsmanship, disrespect of fellow students and/or instructors,
physical aggression and the like. The determination of unacceptable behavior is at the discretion of the
Chess Club manager and/or any of the coaches. Signing up for the class denotes acceptance of this
policy. No refunds will be given.
________________
Date
___________________________________________
Signature of parent/guardian
LRBE CHESS CLUB
Student Information Form
Please inform the LRBE Chess Club Manager(s) in the space provided below of any
allergies, health concerns and/or special needs that your child has. This includes, but
is not limited to, an epi-pen in their bag, an inhaler in their bag, Benadryl, an injury,
and the like.
Student Name:___________________________________________________________
Health Concern:__________________________________________________________
__________________________________________________________________________
Health precaution actions: ________________________________________________
__________________________________________________________________________
Emergency action plan/ medications _____________________________________
__________________________________________________________________________
Please note, the nurse’s office will be open only until 3:30 pm.
Lincoln School Students: your child’s emergency medication(s) can be accessed at the
nurse’s office at Lincoln by the Chess on site supervisor. However, because Chess Club runs
until 4:45pm, please send another set of your child’s medications as back up.
Non-Lincoln Chess Club members do have access to the nurse's office, BUT NOT TO
THEIR EMERGENCY MEDICATIONS, so the STUDENT(S) must bring any emergency
medication with them to Chess Club.
I, as parent or legal guardian of the above named student, give my consent to North
Shore School District 112 to release and receive medical information on my child to
the CHESS program administrators, the LRBE Chess Club manager and coaches, and
any other teachers/coaches.
_____________________________________________________
Parent signature
_____________________
Date
Give three contact #s: 1._________________2.________________3._________________
Chess Club runs from October 1, 2015 through March 24, 2016 from 3:17pm-4:45pm.
Pick up is at the MPR (caféteria) door on the north side of the building.
North Shore School District 112
Extracurricular
Parental Permission and Waiver of Liability
Program: __Chess Club________________Start Date: __October 1, 2015____
Program Description:
LRBE (Lincoln/Ravinia/Braeside/Edgewood) Chess Club meets at Lincoln School after school on Thursdays.
NSSD 112 affords every student with opportunities to explore personal interests and talents. We believe that
every student can find success and pleasure in one or several before or after school activities. Participation in
intramural sports, as well as any extracurricular activity or club, especially transportation to an away activity
involves an inherent risk of injury. However, the Board of Education of the School District cannot assume
responsibility for the safety and welfare of students while they are on or off campus beyond making reasonable
provision for their supervision by representatives of the School District designated to supervise the activity.
Students requiring emergency medication, such as, but not limited to, Epi-pens, asthma inhalers or
supplies for diabetes care, are encouraged to self-carry their medication. If your child is unable to selfcarry his/her emergency medication, it is requested that the parent/guardian provide a second set to the
coach or activity sponsor. Please note: The second set will be returned to the parent/guardian after the
activity is finished. Please contact your school nurse for appropriate self-carry medication authorization
forms and/or medication authorization forms. All medication authorization forms must be completed
and returned in order to participate in the activity. Accommodations for all children needing emergency
medication must be arranged with the activity sponsor or coach. Please indicate on the bottom of this
form if emergency medication is necessary.
I, _________________________ hereby authorize the staff of NSSD 112 to act for me according to their best
judgment in any emergency requiring medical attention and I hereby authorize NSSD 112 and its employees
and agents, in my behalf and stead, to administer or to attempt to administer medical aid when necessary for
any injury or illness incurred while participating in a school sponsored activity and/or during the transportation to
and from a school sponsored activity. I authorize treatment of my child by a qualified physician or nurse in the
event he/she should require medical attention. I acknowledge that it may be necessary for the administration of
first aid and/or emergency medications to my child to be performed by an individual other than the school nurse,
and specifically consent to such practices. As a guardian of a student in NSSD 112, I agree to hold harmless
and indemnify the District, its employees and agents, either jointly or severally, except for willful and wanton
conduct, from and against any and all claims, damages, causes of action, injuries, costs and expenses,
including attorney’s fees, incurred or resulting from the administration or attempt at administration of medical aid
or the arrangement for emergency medical assistance and treatment.
I have read and fully understand that as the Parent/Guardian of this student, I accept general liability for the
participation of my child in an extracurricular activity and waive and release all claims. All emergency medication
requirements necessary for my child are listed on this form. I understand that all medication authorization forms
need to be completed and on file with the school nurse.
Emergency Medication Required? Yes or No (Please circle and indicate what it is)
__________________________________
Parent/Guardian Signature
_________________________________
Student Name
Revised 9-2-15
________________________
Date