First Name (required):     Last Name (required):

Birthday: (mm/dd/yyyy)

Gender: ---MaleFemale Ability: ---Never PlayedBeginnerAdv BeginnerIntermediateAdv IntermediateAdvanced

Street Address:

City: State: ZIP:

Email (required): Home Phone:

Work Phone: Cell Phone:

Select Session(s):
Please only register for the appropriate level. Gino has final approval on level selection.

2.5: Mondays, 9:30-Noon
 Jun 25 Jul 2 Jul 16 Jul 23 Jul 30 Aug 6 Aug 13 Aug 20 Aug 27

3.0: Wednesdays, 9:30-Noon - Early Session is Full

3.0: Wednesdays, Noon - 2:30 pm
 Jun 27 July 11 July 18 Jul 25 Aug 1 Aug 8 Aug 15 Aug 22 Aug 29

3.5: Thursdays 9:30-Noon - Early Session is Full

3.5: Thursdays Noon-2:30 pm
 Jun 28 Jul 5 Jul 12 Jul 19 Jul 26 Aug 2 Aug 9 Aug 16 Aug 23 Aug 30

3.0/3.5: Fridays, 9:30-Noon
 Jul 6 Jul 20 Aug 3 Aug 10 Aug 17 Aug 24 Aug 31

4.0: Tuesdays, 9:30-Noon
 Jun 26 Jul 3 Jul 10 Jul 17 Jul 24 Jul 31 Aug 7 Aug 14 Aug 21 Aug 28

4.0: Fridays, Noon - 2:30 pm (MEN ONLY)
 Jun 29 Jul 6 Jul 13 Jul 20 Jul 27 Aug 3 Aug 10 Aug 17 Aug 24 Aug 31

If a date is not shown above then that date has been filled.

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: Date:

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

EMERGENCY CONTACT: EMERGENCY PHONE: