TENNIS ACADEMY

$38.50 PER MONTH FOR 2 SESSIONS OR $48.50 PER MONTH FOR 3 SESSIONS

    First Name:

    Middle Name:

    Last Name:

    Date of Birth:

    Age:

    Home Phone:

    Work Phone:

    Address:

    P.O.Box:

    City:

    Island:

    Email:

    Sex:

    Parental Information

    Father's Name:

    Phone Number:

    Mother's Name:

    Phone Number:

    Emergency Contact

    Name:

    Address:

    Phone:

    City:

    Island:

    P.O.Box:

    Relationship:

    Email:

    Names of person picking up Child:

    Does your child suffer from any medical condition that could affect his/her participation or Good health:

    If Yes please state the condition:

    Does your child take medication for Illness:

    Waiver Agreement

    In signing this form, the participants’ parent/guardian/signatory assumes full responsibility for the above named person’s participation in the ymca and its activities and hereby indemnifies the ymca board of directors, all it’s employees, instructors, servants, agents and/or volunteers from any and all liability, legal damages, cost, proceedings, actions and charges in the event of accident and/or injury and the like of any kind, or in the event that medical attention is required, hereby agrees to permit staff of the ymca to perform basic first aid and/or allow competent medical authority to render medical aid and attention to ensure the safety, care and welfare of the person in need. The signatory accepts full financial responsibility for any and all medical attention given and received.

    Signatures

    I authorize the verification of the information provided on this form as to my credit and employment. I have received a copy of this application.

    Applicant's Signature:

    Date:

    Staff's Signature:

    Receipt Number:

    NOTE: In the event of an accident the participant may be taken to the hospital to ensure their immediate safety, care and welfare. Whilst every effort to ensure that no child is put at risk after the activity is over, you are asked to ensure that you pick up your child(ren) on time to avoid them being put at risk when left to wait for parents to arrive or when left unattended by parents/guardians.