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Beginner Tennis Instruction Summer 2024
PLAYER INFORMATION
*
First Name:
*
Last Name:
Street:
City:
State:
Zip Code:
Home Phone:
*
Cell Phone:
*
Gender:
Male
Female
*
Parents Email:
*
Divisions (Grade as of Sept/2023):
3rdGrade (First Session 9am - 9:55am)
4th Grade (First Session 9am - 9:55am)
1st Grade (Second Session 10:00am - 10:55am)
2nd Grade (Second Session 10:00am - 10:55am)
5th Grade (Third Session 11am - 11:55am)
6th Grade (Third Session 11am - 11:55am)
7th Grade (Third Session 11am - 11:55am)
8th Grade (Third Session 11am - 11:55am)
*
T-Shirt Size:
Select One
Child Small (size 6-8)
Child Medium (size 10-12)
Child Large (size 14-16)
______________________
Adult Small
Adult Medium
Adult Large
Adult X-Large
Adult XX-Large
______________________
PARENT/GUARDIAN INFORMATION
Firstname:
Lastname:
Second Email (optional):
Home Phone:
Cell Phone:
MEDICAL/EMERGENCY CONTACT INFORMATION
Emergency Contact:
Phone:
Insurance Carrier:
WAIVER INFORMATION
RELEASE OF LIABILITY FOR MINOR PARTICIPANTS
READ BEFORE SUBMITTING FORM
IN CONSIDERATION OF allowing my child/ward, being allowed to participate in any way in the Deer Park Elite Athletic related events and activities, the undersigned acknowledges, appreciates, and agrees that:
The risk of injury to my child from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,
FOR MYSELF, SPOUSE, AND CHILD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES or others, and assume full responsibility for my child’s participation; and,
I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child’s readiness for participation and/or in the program itself, I will remove my child from the participation and bring such attention of the nearest official immediately; and,
I myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Deer Park Elite Athletic; its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my child’s involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I, for myself, my spouse, my child, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING OR CLICKING THE SUBMIT FORM BUTTON, AND AGREE FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
I understand the seriousness of the risks involved in participating in this program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant, by clicking the SUBMIT FORM button, I agree to this waiver.
I/we agree with the above
*
Comments:
Registration Fee is as follows:
$75 for this Summer Session and it includes a Free Tennis Racket or
$60 if you are bringing your own tennis racket or
The fee can be paid via the following methods:
Cash (during in person registration)
Check (during in person registration)
'Zelle' by Chase
Phone # 917-705-5355 (My Name Joseph Gonzalez will appear)
'Credit Card': You must contact me directly to process credit card payments.
(An add'l fee of $4 per registration will be assessed for credit card payment)
Call Mike Gonzalez at 917-705-5355 for any questions.
* indicates required fields