CFA Chess & Science Program Form

Concerned Fathers Association

The Concerned Fathers Association

Presents:

CFA Chess & Science Program

Begin: Saturday, September 26th, 2026

Grades K-12 10-week program (Saturdays) donation $20

Where: Wyandanch-Wheatley Heights Ambulance Corp

(295 Merritt Avenue, Wyandanch NY, 11798)

Time: 11:00AM – 1:00PM

Participant’s Last Name

Participant’s First Name

Parent/Guardian’s Last Name

Parent/Guardian’s First Name

Address

Address Line 1

Address Line 2

City

State

Zip Code

Date of Birth

Home Phone

Cell Number

Family E-mail Address(s)

Grade

School

Level

I, the parent/guardian of _______________________ grant permission for their participation in the Concerned Fathers

Association Chess & Science Program (CFA). I hereby waive, release, and agree to hold harmless the Concerned Fathers

Association, its officers, organization, consultants, volunteers, or the facility where the program will be held from any

claim arising from any injury or loss to my child. Any willful damage to equipment will be billed to the participant.

I hereby grant the CFA permission to use my child’s likeness in a photograph, video, or other digital media in any and all

of its publications, including web-based publications, without payment or other consideration.

Signature

The CFA Chess & Science Program is designed to offer a skill-based chess program to grades K-12 students of all levels from beginner to advanced. Emphasis will be on achieving excellence in problem solving, creativity and logical reasoning skills while making new friends with similar interests. The Science component is designed to focus on exposing the students to STEM related topics and activities.

Facebook: https://www.facebook.com/CFALongIsland

Webpage: www.cfali.org .

Mail: The Concerned Fathers Association PO Box 681 Wheatley Heights NY 11798.

Donations: Zelle/PayPal: treasurer@cfali.org

Checks: Concerned Fathers Association.

Completed registration forms can be emailed to the contact emails listed below.

Contact Oliver Akinrele at 631.875.3282 (oakinrele@hotmail.com) or Julian Gobourne at 631.889.4106 (jurea6@verizon.net) with questions regarding the CFA Chess & Science Program.

The Concerned Fathers Association is a 501(c)(3) nonprofit.