Nassau Tennis Club

First Name (required):

Last Name (required):

Email (required): Home Phone:

Work Phone: Cell Phone:

Birthdate (dd/mm/yyyy):

Gender:  Male Female

Ability: ---Beginner (2.0)Adv. Beginner (2.5)Intermediate (3.0)Adv. Intermediate (3.5)Advanced (4.0+)

Street Address:
City: State: Zip Code:

Select Program:
---Adult Workshop (2.5-3.5): 7-8:30 pmDrill & Kill (3.5 and higher): 7-9 pm

Summer Only! Pick the days you want to play:
Mondays:
 Jun 24 Jul 1 Jul 8 Jul 15 Jul 22 Jul 29 Aug 5 Aug 12 Aug 19 Aug 26

Tuesdays:
 Jun 25 Jul 2 Jul 9 Jul 16 Jul 23 Jul 30 Aug 6 Aug 13 Aug 20 Aug 27

Wednesdays:
 Jun 26 Jul 10 Jul 17 Jul 24 Jul 31 Aug 7 Aug 14 Aug 21 Aug 28

No clinic on July 3

Thursdays:
 Jun 27 Jul 11 Jul 18 Jul 25 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29

No clinic on July 4

Notes:

Membership: ---Family MembershipAdult MembershipJunior Membership Status: ---Current MemberTime to RenewNew Member

Liability Waiver
It is expressly agreed that all use of the Tennis and/or Fitness Facilities and/or Pool at Nassau Racquet & Tennis Club (“the Club”) shall be undertaken by an Adult Participant (“Participant”) at his or her sole risk, and the Club shall not be liable for any injuries or damage to any Participant or guest, or the property of any Participant, or be subject to any claim, demand, injury or damages whatsoever, including, without any limitation, those damages resulting from acts of active or passive negligence on the part of the Club, its successors or assigns, as well as its officers and agents, for all such claims, demands, injuries, damages, actions or causes of actions. It is specifically agreed that the Club shall not be responsible or liable to Participants for articles or property lost or stolen in the Club. It is also agreed that any damages to the Club facilities or property or to the property of any Participant by another Participant is the sole responsibility of the offending Participant.

Signed (Required): Date:

Above named Adult Participant agrees to the Liability Waiver with this electronic signature.

EMERGENCY CONTACT:

EMERGENCY PHONE: