• House of Tennis Junior Program at the Madeira School Registration Form

    House of Tennis Junior Program at the Madeira School Registration Form

    Please fill out and sign all forms below. Forms must be filled out and payment made prior to program attendance.
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  • School Information

  • Family Information

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  • Emergency Contact Information

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  • COVID-19 Liability Release Waiver

  • The World Health Organization has declared the novel Coronavirus (COVID-19) a worldwide pandemic. Due to its capacity to transmit from person-to-person through respiratory droplets, the government has set recommendations, guidelines, and some prohibitions which House of Tennis adheres to comply.

  • By signing below I acknowledge that I have read the foregoing Liability Release Waiver and understand its contents; that I am at least eighteen (18) years old and fully competent to give my consent; That I have been sufficiently informed of the risks involved and give my voluntary consent in signing it as my own free act and deed; that I give my voluntary consent in signing this Liability Release Waiver as my own free act and deed with full intention to be bound by the same, and free from any inducement or representation. This waiver will remain effective until laws and mandates relevant to COVID-19 are lifted.
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  • Medical/ General Liability Release Form

    Medical Information

  • Medical Authorization

    When I or the emergency contact cannot be reached, I give my consent and permission for the above-named doctors to provide medical attention to my child. In the event that the doctors listed above cannot be contacted or in the event of an emergency I give any licensed physician, dentist, hospital or health care provider consent to perform emergency medical treatment at my expense as deemed necessary for the well-being of my child. This may include transportation to the nearest emergency room. 
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  • House of tennis dmv release and indemnity as a player, user or guest at House of Tennis (HOT) facilities, i assume the risk of injury to myself and my invitees including any minor children for whom i am parent, legal guardian, custodian or otherwise responsible due to negligence by HOT, or any of their employees, managers, contractors, consultants or instructors.(each such named party and each of their invitees are referred to as a “HOT party.”)

    I waive and release (i.e., give up) all rights that I, my heirs, representative(s) and/or assigns, and any minor children of mine, may make against any HOT Parties arising from any damages, or injury which I or any of my invitees might sustain as a result of any activity related in any way to HOT. I further agree to indemnify and hold harmless HOT and its owners, manager(s), The Madeira School, employees, and partners from any claims which may be made by me and/or any of my invitees or which might be made against me and/or any of my invitees by others, arising from any activity related in any way to HOT; and from any claims relating to any injury, loss of or damage to any personal property which might occur from any activity by me and/or my invitees related in any way to HOT.  I (on behalf of myself and any minor children invitees for whom I am parent, legal guardian, custodian or otherwise responsible) consent to the rendering of emergency first aid and other medical procedures, which at the time of injury or illness seem reasonably advisable.   WITHOUT LIMITATION OF THE FOREGOING, I UNDERSTAND THAT I AM GIVING UP ANY RIGHT I AND MY MINOR CHILDREN HAVE TO SUEOR MAKE A CLAIM AGAINST HOUSE OF TENNIS, THE MADEIRA SCHOOL, DMV TENNIS LLC, FAIRFAX COUNTY SCHOOL BOARD, AND FAIRFAX COUNTY PARKS AND RECREATION FOR ANY INJURIES ANY ONE OF US MIGHT SUSTAIN WHILE USING FACILITIES, EQUIPMENT AND/OR SERVICES PROVIDED BY HOT, AND THAT I AM INDEMNIFYING AND HOLDING HARMLESS HOT AND ITS MANAGEMENT AGAINST CLAIMS BY ME AND/OR ANY OF MY INVITEES INCLUDING ALL MINOR CHILDREN I INVITE OR WHO ARE UNDER MY CARE.  I attest that I am eighteen (18) years or older, and that my child is physically fit and has no known medical conditions which prohibit participation in this sport. My child and I agree to follow all laws, rules and guidelines regulating the conduct of camp, clinic or league. Notwithstanding any other provision hereof, I do not give up any claim against a specific HOT Party for reckless and wanton conduct by that specific party. I also agree that HOT and its agents, sponsors, and employees may use my child’s image and likeness in future promotions. 
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