Clone of Registration form

Registration form
Step 1: Which program is your child being registered for?

Parent/Guardian Information

Please provide the primary parent or guardian's contact information so we can communicate program updates, schedules, weather notifications, and other important information.
Name

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

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Relationship to the child
Additional Contacts

Please provide the name and contact information for someone we can reach in the event of an emergency if a parent or guardian is unavailable.
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship

Household Information

To help determine your family's registration fee and continue providing affordable programs for children throughout our community, we ask all families to complete the following household information.

Your information will be kept confidential and used only to determine your child's weekly registration fee and program eligibility.

Please refresh the page if you choose multiple Household Sizes and/or Income Ranges.
Household Size
Income Range - Household of 2
Income Range - Household of 3
Income Range - Household of 4
Income Range - Household of 5
Income Range - Household of 6
Income Range - Household of 7
Income Range - Household of 8
Income Range - Household of 9
Income Range - Household of 10
Based on the information you provided, your child's weekly registration fee is estimated to be:

$0

No payment is needed at this time. Once the registration form has been submitted and all information has been reviewed, you'll receive an email detailing next steps.
Based on the information you provided, your child's weekly registration fee is estimated to be:

$10

No payment is needed at this time. Once the registration form has been submitted and all information has been reviewed, you'll receive an email detailing next steps.
Based on the information you provided, your child's weekly registration fee is estimated to be:

$20

No payment is needed at this time. Once the registration form has been submitted and all information has been reviewed, you'll receive an email detailing next steps.
Verification Documentation

To help us determine your family's registration fee, please upload one document showing your current household income or eligibility.

Examples include:

Medicaid Approval Letter
SNAP Approval Letter
Most recent federal tax return (first page)

Your information will be kept confidential and used only to determine program eligibility and registration fees.
File Upload

Cancelof

Photo Consent: by clicking yes, you give Tennis Success permission to take and use any photographs or other media, without limitation or obligation, of your child to promote Tennis Success programs now or in the future.
Signature: by providing your name above you are stating, I have read and understand the above application and do herby attest the information provided by me on this and other related program forms to be correct and completed to the best of my ability giving permission to Tennis Success to provide the services indicated.
Parent Email Address
example@example.com
Should be Empty:

Registration form

Child information

Parent/Guardian Information

Additional Contacts

Medical Form

Insurance Information

Medications (inhalers included):