PS 290Q Afterschool Program
55-20 Metropolitan Avenue, Ridgewood, NY 11385 | September 2026 - January 2027
STUDENT 1 INFORMATION
Student's Name
*
First Name
Middle Name
Last Name
Grade
*
Grade (Number Field)
*
School
*
Teacher/Room Number (if known)
*
Skill Level
*
Please Select
Pawn 1 (Beginner 1) - Absolute Beginners
Pawn 2 (Beginner 2) - Knows the movements and values of pieces
Knight (Beginner 3) - Can do checkmate with Queen+King, and 2 Rooks
Bishop (Intermediate 1) - Can do checkmate with only 1 Rook+King, and knows what "opposition" is
Rook (Intermediate 2) - Players with USCF rating of 800-1299
Queen (Advanced 1) - Players with USCF rating of 1300-1800
King (Advanced 2) - Players with USCF rating of 1800 and above
Not sure
Allergies or anything else we need to know?
Is the child authorized for self-dismissal?
*
Yes
No
STUDENT 2 INFORMATION
Student's Name
First Name
Last Name
Grade
Grade (Number Field)
School
Teacher/Room Number (if known)
Skill Level
Please Select
Pawn 1 (Beginner 1) - Absolute Beginners
Pawn 2 (Beginner 2) - Knows the movements and values of pieces
Knight (Beginner 3) - Can do checkmate with Queen+King, and 2 Rooks
Bishop (Intermediate 1) - Can do checkmate with only 1 Rook+King, and knows what "opposition" is
Rook (Intermediate 2) - Players with USCF rating of 800-1299
Queen (Advanced 1) - Players with USCF rating of 1300-1800
King (Advanced 2) - Players with USCF rating of 1800 and above
Not sure
Allergies or anything else we need to know?
Is the child authorized for self-dismissal?
Yes
No
STUDENT 3 INFORMATION
Student's Name
First Name
Last Name
Grade
Grade (Number Field)
School
Teacher/Room Number (if known)
Skill Level
Please Select
Pawn 1 (Beginner 1) - Absolute Beginners
Pawn 2 (Beginner 2) - Knows the movements and values of pieces
Knight (Beginner 3) - Can do checkmate with Queen+King, and 2 Rooks
Bishop (Intermediate 1) - Can do checkmate with only 1 Rook+King, and knows what "opposition" is
Rook (Intermediate 2) - Players with USCF rating of 800-1299
Queen (Advanced 1) - Players with USCF rating of 1300-1800
King (Advanced 2) - Players with USCF rating of 1800 and above
Not sure
Allergies or anything else we need to know?
Is the child authorized for self-dismissal?
Yes
No
PARENT/GUARDIAN'S INFORMATION
Parent/Guardian's Name
*
First Name
Last 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 (Please provide contact information)
PROGRAM REGISTRATION
Select Session
*
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Mondays - Full Program (16 sessions)
Early registration discount and sibling discounts available
$400.00
$
400.00
Quantity
1
2
3
Tuesdays - Full Program (18 sessions)
Early registration discount and sibling discounts available
$450.00
$
450.00
Quantity
1
2
3
Debit or Credit Card
First Name
Last Name
Credit Card Number
Security Code
Expiration Month
January
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Expiration Month
Expiration Year
2026
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2045
Expiration Year
Additional Information
Refund Policy, Terms, and General Media Release
*
I understand that all cancellations require at least 24 hours notice prior to the program date to receive a full credit toward any other NYCA program. Credits never expire and are transferable. If a refund to the original payment method is preferred over a credit, a 5% processing fee will be deducted to cover non-refundable third-party transaction costs. I also acknowledge and agree to the Academy's policies regarding student behavior and late pick-up fees as outlined on the NYCA website. Additionally, 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 for use in any educational or public media as deemed appropriate by the Academy.
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