Student's Name(s) ______________________________________________________________________________________________
Parents Name(s) ______________________________________________________________________________________________
Address ______________________________________________________________________________________________________________
Student's Age(s) _________ T-shirt Size(s) ________
Cell Phone(s)______________________________________________________________________________________________________
Email_________________________________________________
Clinic Name (e.g. "Juniors")_______________________________________________
Session Start Date____________ Fee________ Late Fee______
Health Concerns_______________________________________________________________________________________________________
Other Concerns or Comments______________________________________________________________________________________________________
Emergency Contact (name and phone)__________________________________________________________________________________
Release (for all students): I do hereby for and on behalf of myself and my heirs and legal representatives release and forever discharge Bob Phillips, managers, and representatives from any and all claims and demands of every kind, nature and character which I may have or here after acquire for any and all damages or losses which may be suffered or sustained by me in connection with my activity, and all such claims are hereby waived and released.
I understand that Bob Phillips' Next Wave Tennis Clinics is fully insured, however; every student is required to provide proof of individual insurance and understands that their insurance coverage is primary.
Furthermore, I understand that any student who does not abide by the rules and regulations promulgated by the clinic, or who displays behavior problems during the clinic, is subject to dismissal from the entire clinic session without reimbursement or recourse. Such action will be administered by Bob Phillips, the Clinic Director, only. Students will not be permitted to leave the clinic without parental consent for any reason other than medical emergency until the completion of the clinic.
I understand that all payments are non-refundable and that late fees will be assessed if registration and payment is not received on or before the registration deadline. I have read and understand the Clinic Information Sheet. I also understand that, after the first clinic class, my child is required to provide their own tennis racquet.
Signature______________________________________Date_______