LockwoodFollyTennis

Athlete Information

Child's Name

First NameLast Name

Birth Date*

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Home Number

Cell Number

E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Alt. Phone Number

T-Shirt

Shoe Type

Shoe Size

Shoe Type

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

Is there anything you would like the coach to know about your child?

Informed Consent and Acknowledgement I hereby give my approval for my child’s participation in the activities prepared by the tennis coach and assistant coaches. In exchange for the acceptance of said child’s participation in Let's try Tennis, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless the Brunswick County Tennis Association. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of participating in the tennis sessions. In case of injury to said child, I hereby waive all claims against the Brunswick County Tennis Association. including all coaches and assistants. There is a risk of being injured that is inherent in all sports activities.. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

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.

Tennis & Tutoring