Registration
Pine Brook, NJ
Program and Date Selection
Please select a lesson
*
Group Lessons - $30/hr for all ages and skill levels
Private Lessons - $50/hr for 1-on-1 tailored coaching
Attendance Date
*
-
Month
-
Day
Year
Participant Information
Name
*
First Name
Middle Name
Last Name
Age
*
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Guardian and Emergency Contact Information
Parent/Guardian Information
*
First Name
Middle Name
Last Name
Relationship
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Information
*
First Name
Middle Name
Last Name
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health
Any medical conditions, allergies, or medications?
*
Yes
No
If yes, please describe
0/500
Waiver & Signature
I acknowledge that: (1) there is inherent risk of injury in tennis activities; (2) I assume all risks of participation; (3) I release TD Tennis Academy, its coaches and representatives from liability; (4) I authorize staff to seek emergency medical care if I cannot be reached
*
Accept
Decline
TD Tennis Academy may photograph the participant for promotional use
*
Accept
Decline
Payment method
*
CashApp - tashadembo
Zelle - (701) 425-6104
Total Amount Due
Signature
*
Date
*
-
Month
-
Day
Year
Submit Registration
Submit Registration
Should be Empty: