Response

Register for Sen. Bernie Sanders' Second Annual Youth Chess Day

The contact information provided in this section should be the information for the parent or guardian of the youth chess participant if the participant is under 18 years old.

If you are registering yourself and you are 18 years old, you can provide your contact information here.

Prefix

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Primary Phone

First and last name of participant:

Grade of participant:

School of participant:

Is the participant in a chess club? If so, name of club:

What is the participant attending:

Learn-To-Play Session

Lunch

Recreational Tournament

Learn-To-Play Session: Open to grades 1-8 only (11:00am-12:15pm)
Lunch: Free for all participants (12:15pm-1:00pm)
Recreational Tournament: Open to grades 1-12 (1:00pm-4:00pm)

The "Learn-To-Play" Session is for students who are new to chess. They may also stay to watch the tournament. The "Recreational Tournament" is for students who already know how to play chess.

Chess experience of participant:

Is the participant US Chess Federation rated? If so, provide rating below:

If the participant has experience playing chess, please describe it in more detail to help us match the participant with other players. For example, does the participant mostly play with family and friends? With a local club? In tournaments?

Students with all levels of experience are welcome and highly encouraged to attend!

If different than the information above, please provide the name and email of the parent, guardian, or chaperone attending the event with the participant:

If you would like to provide contact information for the participant, provide email here:

Permission to attend:

By submitting this form, the participant (if 18 years old), or the parent or legal guardian of the above-named minor participant, gives permission to attend this event. If the above-named participant is under 18, they will be accompanied by the adult listed above.

By submitting this form, the participant (if 18 years old), or the parent or legal guardian of the above-named minor participant, gives consent to the United States Senate Office of Bernie Sanders to use the participant's image and likeness and/or any interview statements in its publications and other print media, mailings, on television, radio and electronic media, including the Internet, without expectation of compensation or other renumeration, now or in the future. This exclusivity pertains to the United States Senate Office of Bernie Sanders. This consent includes, but is not limited to:

Permission to interview, film, photograph, tape, or otherwise make a video reproduction of the participant and/or record their voice;
Permission to use the participant's name; and
Permission to use quotes from interview(s), film, photograph(s), tape(s), or reproduction(s) of the participant, and/or recording of their voice, in part or in whole.

This consent is given in perpetuity, and does not require prior approval.

NOTE: This event is NOT an official chess tournament; it is a recreational chess event.

In order to organize the "Recreational Tournament", there will be a set number of playing spots based on grade level. A member of Senator Sanders' staff will contact you to confirm the participant's spot after you submit this registration form.

If you have any concerns about the above permissions, please contact Senator Sanders' office at 802-862-0697.

To request an accommodation or interpretation services for the participant, please contact Senator Sanders' office at 802-862-0697.