JUNIOR LEVEL DESCRIPTION

Pre-member Junior TEnnis Program enrollment

* Indicates required field

Name *

First

Last

Birth Date (MM/DD/YYYY) *

Age *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Select a class level
Pre-member may only enroll in Level 1 *

Contact phone *

Parent #1 Contact Information *

First

Last

Parent #1 Contact Phone *

Parent # 1 Email *

Parent #2 Contact Information *

First

Last

Parent #2 Contact Phone *

Parent #2 Email *

Emergency Contact #1
This person has permission to pick up my child from the Club *

First

Last

Relationship to Child *

Emergency Contact # 2
This person has permission to pick up my child from the Club *

First

Last

Relationship to Child *

Contact Phone *

Child's Interests *

How did you hear about the Club? *

LIABILITY AND MEDICAL RELEASE (PLEASE READ AND ACKNOWLEDGE)

1) 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.
2) 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 medial care and/or emergency surgery WITHOUT INCURRING ANY LIABILITY.

I am a parent or guardian *

Yes

I have read, understood and accepted the conditions of the liability and medical release printed above. *

Yes

Don't forget to send a separate payment via PayPal to manager@edgebrookclub.org

Submit

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