Ed Zelkind Summer Camp Registration Form

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

Ed Zelkind
1848 Turquoise Trail
Eagan, MN 55122

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

July      19 - 23   ** Full   ** Morning   ** Afternoon
August  2 - 6      ** Full   ** Morning   ** Afternoon
August  9 - 13    ** Full   ** Morning   ** Afternoon

Camper Name: ____________________________________________________
Parent's Name: ____________________________________________________
Address: _________________________________________________________
City/State/Zip: _____________________________________________________
Day Phone: _____________________   Evening Phone: ____________________
Cell Phone: _____________________   Emergency Phone: __________________
Email: __________________________ School: __________________________

Please list any pre-existing health conditions we should know about:
____________________________________________________
____________________________________________________

Skill level:

_____    Beginner (Little or no experience)
_____ Advanced Beginner (Can checkmate with King and Queen or King and Rook)
_____ Intermediate (Has several years tournament experience)
_____ Advanced (Has USCF rating and/or group or private lessons)

T- Shirt Size (circle one)
Kids 6-8
Kids 8-10
Adult Small
Adult Medium
Adult Large
Adult Extra Large