PS 69Q Afterschool (September 2025

PS 69Q - The Jackson Heights School

77-02 37th Avenue Jackson Heights, NY, 11372 | (September 18, 2025 - January 29, 2026)

Student's Name*

First NameLast Name
Age*
Grade*
School*
Skill Level*
Allergies or anything else we need to know?
YesNo

Student's Name

First NameLast Name
Age
Grade
School
Skill Level
Allergies or anything else we need to know?
YesNo

Student's Name

First NameLast Name
Age
Grade
School
Skill Level
Allergies or anything else we need to know?
YesNo

Parent/Guardian's Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Emergency Contacts / Authorized Person to Pick-up

Select Program*

Thursdays - Full Program (15 sessions)

$28/session | 5% sibling discount for the second and subsequent child - automatically applied in the registration.

$420.00 Quantity

Thursdays - Single Day Drop-in

Single day drop-in sessions. Please select the quantity from the drop-down, and enter the dates you are signing up for in the "Drop-in Session Dates" text field below.

$30.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

September 18, 2025September 25, 2025October 9, 2025October 16, 2025October 23, 2025October 30, 2025November 13, 2025November 20, 2025December 4, 2025December 11, 2025December 18, 2025January 8, 2026January 15, 2026January 22, 2026January 29, 2026
Additional Information
I understand that all cancellations require at least 24 hours prior to the day of the program in order to receive full credit for the purchased amount to be applied toward any other NYCA programs. Credits never expire and are transferable. Refund requests are considered on a case by case basis. I hereby authorize New York Chess Academy (NYCA) to photograph, take motion pictures, video footage, and/or make electronic sound recordings of the participant I am registering. I authorize the use of any such photographic or electronic reproductions for any purpose, including, but not limited to educational and other public media as may be deemed appropriate by the New York Chess Academy.
Please verify that you are human*
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PS 69Q - The Jackson Heights School