SCTA Detailed Registration Form

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. *

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Southern California Tennis Academy (SCTA) during the selected camp. In exchange for the acceptance of said child’s registration by SCTA, I/We assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless SCTA. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Southern California Tennis Academy (SCTA). including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including Tennis.

Parent/Guardian Responsibilities

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

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

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

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

Program Option *

High Performance Program - Long Beach Costa Mesa **FULL** FUNdamentals Program - Long Beach

My Products

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Date	Postal Code

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

RSVP to ayca@sctennisacademy.com after you register for Long Beach

RSVP to rc@sctennisacademy.com after you register for Costa Mesa

SCTA School Year Registration