Class Sign-Up Form        

Activity Description

Fee

Kids Group Class May 3rd - June 30th, 2019

(Tue 5:30pm, Fri 5:30pm, Sun 1:00pm)

$175

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For office use only:

Class Type __________________________________   Start Date _________________________ End Date  ______________________

Contact Information:

Parent / Guardian’s Name:

Child’s Name:

Mobile Phone

E-mail Address

Billing Address

        

Credit Card #

Expiration Date

CVV

OR, Online Pmnt code:

South Bay Table Tennis Release & hold harmless agreement / Authorization for treatment of a minor.

In consideration of the participation of ____________________, and with complete understanding said participant will take a physical test of ping pong skills, I (we) understand and agree to the following:

____________________ (participant), is hereby given my consent to participate in organized practices, activities and competition at South Bay Table Tennis. I give permission for South Bay Table Tennis to use pictures of my child in the future for publicity use only.

______________________________________              ___________________                _______________________

Parent / Guardian Signature                                                              Date                                Phone #

The undersigned does hereby waive, release, acquit and forever discharge South Bay Table Tennis, its officers and directors, collectively and individually, coaches, and adult supervision, and any and all persons directly or indirectly associated with South Bay Table Tennis from any and all acts, cause of action, claims, demands, damages, cost or expenses on account of or which may in any way develop out of any and all known and unknown personal injuries or property damage which the player/participant may suffer during the course of or as a result of the participation at South Bay Table Tennis including, but not limited to, kids classes, group training, private lessons, tournaments, table rentals, open play, or league competition.  

I hereby acknowledge that I am the parent and/or guardian of the above mentioned minor. I give authorization to any properly licensed physician or surgeon to provide emergency medical care and/or treatment when necessary. Any expenditure for care and treatment is my responsibility.

_______________________     ___________     __________________________     __________________________

Signature of Parent/Guardian         Date                     Print Name of Parent                         Print Name of Participant

South Bay Table Tennis ✦ 540 Maple Avenue, Torrance, CA 90503 ✦ (310) 951-2437 ✦  www.sobaytt.com