Student Name *

First Name

Last Name

Parent/ Guardian Name *

First Name

Last Name

Parent/ Guardian Phone Number *

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Virtual Courses of Interest *

Select all that apply

Afternoon Chess Lessons

After School Chess Lessons

Beginner Chess Lessons (for youth)

Beginner Chess Lessons (for adults)

Chess Lessons for Parents

Coding for Kids (Pre-Coding)

Coding for Kids (Advanced)

Math is Money (Financial Literacy)

Small Group Math Tutoring

Chess and Entrepreneurship (for Adults)

Media Consent Form and Release *

I hereby consent to have my child photographed, digitally recorded, video taped, audio taped and/ or interviewed by Ahead of the Game Academy (“ATGA”) or the news media when class is in session or when my child is under the supervision of ATGA. I understand in the course of the above described activities that ATGA might like to celebrate my child’s accomplishments and work. I understand that I may cancel this consent by providing written notice to the executive director. I also understand that my consent to have my child photographed, digitally recorded, video taped, audio taped and/or interviewed by ATGA or the news media when class is in session or when my child is under the supervision of ATGA is valid until I cancel this consent.

I consent as outlined in the above consent/ release section.

I DO NOT consent as outlined in the above consent/ release section.