Edgebrook Swim and Tennis Club
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Pre-member Junior TEnnis Program enrollment
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Indicates required field
Name
*
First
Last
Birth Date (MM/DD/YYYY)
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Age
*
Address
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Line 1
Line 2
City
State
Zip Code
Country
Select a class level
Pre-member may only enroll in Level 1
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Level 1 (U8), $112
Level 1 (U10), $112
Level 1 (11+), $112
Contact phone
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Parent #1 Contact Information
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First
Last
Parent #1 Contact Phone
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Parent # 1 Email
*
Parent #2 Contact Information
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First
Last
Parent #2 Contact Phone
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Parent #2 Email
*
Emergency Contact #1
This person has permission to pick up my child from the Club
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First
Last
Relationship to Child
*
Emergency Contact # 2
This person has permission to pick up my child from the Club
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First
Last
Relationship to Child
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Contact Phone
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Contact Phone
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Child's Interests
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How did you hear about the Club?
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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
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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
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