JTC Spring '22 Registration Form

Athlete Information

Athlete's 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

Parent/Guardian Information

Name

First Name Last Name

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First Name Last Name

Relationship

Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Which program are you interested in?

Junior Program (ages 10 and under)-Red/Orange Ball Middle/High School Program (ages 12 and up)- Yellow Ball

What day(s) would you like to attend? (click all that apply)

Monday 4:30-5:30 Jr. Program Monday 5:30-6:30 Jr. Program Monday 5:30-7:00 Middle/High School Program Wednesday 4:30-5:30 Jr. Program Wednesday 5:30-6:30 Jr. Program Wednesday 5:30-7:00 Middle/High School Program Saturday 9:00-10:00 Jr. Program Saturday 10:00-11:30 Middle/High School Program

How many days would you like to attend?

1 day per week 2 days per week

What Package would you like? Note-This is a 19 week program lasting all semester.

Pay as you go ($15/class-Jr Program, $22.50/class- Middle/High School Program) 1 day/week package ($250-Jr. Program, $375-Middle/High School Program) 2 days/week package ($500-Jr. Program, $750-Middle/High School Program)

What will be your method of payment?

Cash Check Venmo (Venmo ID:Jonesvilletennis-352)

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement I hereby grant my permission as parent/legal guardian for the above named athlete, to attend sports activities at the Jonesville Tennis Center and I further authorize the Jonesville Tennis Staff to act for me in their best judgment in any emergency requiring medical attention in the event that I may not be reached.

I hereby waive Jonesville Tennis LLC., its staff, and Alachua County any and all liability and any injury incurred while involved in the Jonesville Tennis programs.

I hereby state that I have carefully read the above waiver. Acceptanceand understanding of this agreement are hereby acknowledged.

I have read and agree to the Informed Consent and Acknowledgement.

COVID-19 Waiver Acknowledgement

I hereby attest to the best of my knowledge that the statements below are true and waive all liability from Jonesville Tennis LLC., its staff, and Alachua County in the event of a positive COVID-19 test result.

I affirm that I, as well as all housedhold members, do not currently have, nor have experienced the symptoms of COVID-19, including, but not limited to: cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or small WITHIN THE LAST 14 DAYS.

I affirm that I, as well as all household members, do not have any pending COVID-19 test results

I affirm that I, as well as all household members, have not been diagnosed with COVID-19 WITHIN THE LAST 14 DAYS

I affirm that I, as well as all household members, have not traveled outside of the country or to any city considered a "hot spot" for COVID-19 infections WITHIN THE LAST 14 days

I understand that neither Jonesville Tennis LLC., nor Alachua County can be held liable for any exposure to the COVID-19 virus caused by misinformation on this form or the health history provided by the athlete.

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.

Spring 2022 Tennis Program Registration