JTC Summer Camp Program 2022

Summer Camp Registration

Tennis Camp- $50/Day, $225/week Sports Camp: $40/Day, $180/week LUNCH WILL BE PROVIDED HOURS WILL BE 9am-1pm (lunch will be at 12pm)
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
Which Program would you be interested in?

Tennis Program Sports Program
Which Session would you like to attend (CHECK ALL THAT APPLY)

Session 1 (Jun 6-10) Session 2 (Jun 13-17) Session 3 (Jun 20-24) Session 4 (Jun 27-Jul 1) Session 5 (Jul 5-8) *4 day week Session 6 (Jul 11-15) Session 7 (Jul 18-22) Session 8 (Jul 25-29) Session 9 (Aug 1-5)
What day(s) would you like to attend (CHECK ALL THAT APPLY)

All week Monday Tuesday Wednesday Thursday Friday
What payment option would you like?

Cash Check (payable to JTC) Venmo (ID: Jonesvilletennis-352)
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 grant my permission as parent/legal guardian for the above named child, to attend sports activities at the Jonesville Tennis Center and I further authorize the Jonesville Tennis Staff to act for me in thier best judgment in any emergency requiring medical attention in the event I may not be reached.

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

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

I have read and agree to the Informed Consent and Acknowledgement.
Covid-19 Waiver and Acknowledgement

I herebey 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 household members, do not currently have, nor have symptoms exeperienced associated with 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 or smell or taste 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 knowingly been exposed to anyone 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.
Should be Empty:

Now create your own Jotform - It's free! Create your own Jotform

Summer Camp Registration