Fall Detailed Registration Form

SCTA School Year Registration

September 1, 2021 thru May 31, 2022
Player Information
Player #1 Name *

First Name Last Name
Birth Date *

Month Day Year
Grade *
Gender *

Male Female
Player #2 Name

First Name Last Name
Birth Date

Month Day Year
Grade
Gender

Male Female
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Parent/Guardian Information
Name *

First Name Last Name
Home Number *

Area Code Phone Number
Cell Number *

Area Code Phone Number
E-mail *
Emergency Information
Emergency Contact's Name *

First Name Last Name
Relationship *
Phone Number *

Area Code Phone Number
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe. *
Is the athlete prescribed an inhaler? If yes, please explain any instructions. *
Parent/Guardian Responsibilities

I/We will inform Southern California Tennis Academy (sctennisacademy) about any serious medical condition or disability of the learner, either existing or arising.

I/We will inform the sctennisacademy immediately of changes of address or telephone number of parents/guardians.

I/We agree that we and our child/children will follow all sctennisacademy policies and regulations.

I/We agree to settle all financial obligations as they come due
Program Option *

High Performance Program - Long Beach FUNdamentals Program - Long Beach Estancia Program - Costa Mesa

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SCTA School Year Registration