Seguin After School Tennis Club

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The Seguin Summer Tennis Club is designed for Seguin area elementary, middle and high schoolers. The program is under the direction of Coach Sam Chadwell, who is a certified USPTA Professional and has been involved in the tennis industry as a player, coach, and community organizer for 30 years. Sam’s passion is to get young people started off on a solid foundation of fundamentals and guide them through the learning process to become an established player.

Program meets Tuesdays at Seguin High School starting June 12.

Grade level 2nd thru 6th meet 8:00 to 9:00 AM

Jr High and High Schoolers meet 9:00 to 10:30 AM

Class Dates: Tues June 12, 19, 26, July 10, 17, and 24

Special offer 6 weeks for only: $30.00

You may pay with cash or check at the first class meeting.

Loaner racquets are available

Deadline to register: June 1

Early Registration Incentive: Sign up and pay by May 24 and receive special pricing on future lessons, play days and tournaments.

If you have any questions contact Coach Sam Chadwell

Text or voice mail: 713-818-9109

email: coachsam@chadwelltennis.com

Athlete Information

Athlete's Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Parent/Guardian Information

Name

First NameLast Name

Home Number

Area CodePhone Number

Cell Number

Area CodePhone Number

E-mail

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

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

Is the athlete prescribed an inhaler? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Coach Sam Chadwell and Seguin ISD during the selected camp. In exchange for the acceptance of said child’s candidacy by Coach Sam Chadwell, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Coach Sam Chadwell, Seguin ISD, and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against SEGUIN ISD. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to Seguin ISD. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

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.