TENNIS STAFF

Student's Name *

First

Last

Student's Full Birthdate *

Choose One *

Male Female

Parent's Name *

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Last

Parent's Home Phone *

Parent's Cell Phone *

Address *

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Line 2

City

State

Zip Code

Country

I would like my account to be set up for auto pay *

Yes - I agree to have my statement balance auto charged on the 20th of each month No - Do not auto charge. I agree to submit payment for my bill monthly

Requested start date of membership *

Immediately 1st day of the next month Unsure, please contact me

I am interested in: *

Junior Tennis Program Private Tennis Lessons Both of the above

LIABILITY AND MEDICAL RELEASE (PLEASE READ AND SIGN) I assume full responsibility for myself, my family, and my guests for any and all injuries, losses, or damages which might occur while on the Edgebrook premises; and to HOLD HARMLESS EDGEBROOK, ITS OWNERS, OFFICERS, AND EMPLOYEES FROM ANY LIABILITY WHATSOEVER FOR INJURIES, LOSSES, OR DAMAGES. In the event of a medical emergency involving myself or my family, I give consent to Edgebrook to provide first aid, and I grant permission to any duly licensed medical personnel and/or medical facility to provide medical care and/or emergency surgery WITHOUT INCURRING ANY LIABILITY. I acknowledge that I have read, understood, and accepted the conditions of the liability release printed above, and have also received a copy of the Junior Membership Policies and agree to abide by the policies set forth. *

By submitting this form you agree that you have read the Jr Membership Policies (top of page) and will abide by them. *

junior tennis Memberships

Junior Tennis membership