Nassau Tennis Club

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:

Program I am interested in: ---FuturesPremier IPremier IIELITESUPREME

Day: ---MondayTuesdayWednesdayThursdayFridaySaturdaySunday Start Time:

Additional or Second Choice Program:  None Second Choice Additional

Choose a Program: ---FuturesPremier IPremier IIELITESUPREME

Day: ---MondayTuesdayWednesdayThursdayFridaySaturdaySunday Start Time:

Notes:

High Performance 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 a Junior Participant (Jr.) at his or her sole risk, and the Club shall not be liable for any injuries or damage to any Jr. or guest, or the property of any Jr., 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 Jr’s 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 Jr. by another Jr. is the sole responsibility of the offending Jr’s parent or guardian.

Additionally, payment is required in advance, and by submitting this form, I explicitly agree to remit full payment for class(es) or program(s) selected herein, whether I attend or not.

Signed: Date:

Above named Parent or Guardian agrees to the Liability Waiver and Payment Commitment with this electronic signature.

EMERGENCY CONTACT: EMERGENCY PHONE: