Giammalva Academy Registration Form

Giammalva Academy Registration Form

Thank you for your interest in our Elite Academy Program. Please fill out the form below to register your child.
Contact Information
Guardian - Full Name

First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Player - Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Please provide a brief description of experience level:
Please select the Academy program you would like to register in:
What days would you like to register ?
How did you hear about Giammalva Elite Academy?

Other
1. Automated Charge / Pre-Authorized Payment Authorization I understand and agree that all program fees, camp fees, guest fees, and other charges incurred by my family will be automatically drafted from my checking account or charged to the credit/debit card on file. *
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2. I authorize Giammalva Racquet Club to initiate pre-authorized electronic funds transfers or charge transactions from the account provided.
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3. I understand that my bank or credit card statement shall constitute my receipt for payment. In the event that a pre-authorized draft or charge is declined or not honored by the financial institution, I agree that I am responsible for payment of all outstanding balances by an alternative method of payment. This authorization shall remain in effect until revoked by me in writing with at least ten (10) days’ notice, and until such notice is received and processed by Giammalva Racquet Club.
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4. I agree that each debit shall have the same force and effect as if it were a check or charge personally signed by me, and that Giammalva Racquet Club shall be fully protected in honoring this authorization provided sufficient funds or credit are available.
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5. Refund & Cancellation Policy Once registered and payment is made for any camp, program, or session, no refunds will be issued unless there is a valid medical reason or other extenuating circumstance, as determined and approved by the Program Director. Prepaid semester or camp fees are non-refundable if a participant does not attend, except in approved cases. Resignation Agreement Applicant may resign from a monthly program by providing written notice at least ten (10) days prior to the next program month or session start date. The effective date of resignation shall be the date the written notice is received by the Club. All accrued fees and charges owed up to the effective date of resignation remain due and payable. Make-Up Policy Classes missed due to illness, vacation, or other personal reasons will not be made up. In the case of an extended medical condition or emergency, the Applicant should contact the Program Director or Pro in charge to discuss possible accommodations. Payment Agreement Applicant agrees to pay all charges when due. The Club reserves the right to assess a late fee of $25.00 on past-due accounts. Disclaimer and Hold Harmless Agreement I voluntarily assume full responsibility for my participation and/or my child’s participation in all Club activities and the use of all facilities, equipment, services, and privileges. I release and hold harmless Giammalva Racquet Club, its owners, directors, officers, employees, agents, and representatives from any and all claims, liabilities, injuries, damages, or losses arising from participation, including those resulting from negligence, to the fullest extent permitted by law. Photo & Media Release I grant permission to Giammalva Racquet Club to photograph and/or video me and/or my child and to use such images for promotional materials, publications, websites, and social media without compensation. Medical Authorization I authorize Giammalva Racquet Club staff to obtain emergency medical treatment for my child from a licensed medical provider as deemed necessary for the child’s health and safety. Transportation Waiver I acknowledge that Giammalva Racquet Club and/or Elite Academy may, at its discretion, provide transportation for participants. I understand that participation is voluntary and assume all risks associated with travel. I release and hold harmless Giammalva Racquet Club & Elite Academy, its owners, directors, employees, and volunteers from any claims arising from transportation services.
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Signature
Terms and Conditions
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Giammalva Academy Registration Form

Contact Information