Program Interest Form
Thank you for taking part in activities at the Specter Center - the world's largest community squash center and home of US Squash!
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
-
Month
-
Day
Year
Date
Participant's Gender
*
Male
Female
Non-Binary
Prefer not to say
Participant's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Participant's School
*
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Email
*
example@example.com
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Emergency Contact: Full Name + Phone Number
*
Do you know your US Squash Club Locker account number? (if you do not have an account please visit spectercenter.org/member login to create one.)
Are you interested in purchasing a Specter Center Membership?
*
Yes
No
Maybe
Already have one!
For inquiries regarding finanial assistance, please contact Hadley.Smink@ussquash.org
Please select the package you are registering for:
*
Clinics
Lessons
Please select the specific activity you are registering for
*
March Clinic Package- 1 junior clinic/week
March Clinic Package- 2 junior clinics/week
April/May Clinic Package- 1 junior clinic/week
April/May Clinic Package- 2 junior clinic/week
10 Private Lessons package
5 Private Lessons package
All Clinic and Lesson packages are non-refundable and must be used by May 26.
*
Please Select
Agree
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Spring Package Initial Payment
A non-refundable payment is required for registration of a Spring package. The remaining balance will be collected within 48 hours of registration.
$
75.00
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.
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