Wait List: 2017 Marcy NEW Student Registration
Welcome to Kings County Tennis League! Please fill out this form to completion to join the wait list for Marcy Tennis Club. All classes are held at Marcy Playground (753 Myrtle Ave, Bed-Stuy, Brooklyn) unless otherwise specified.
Student's First Name
Your answer
Student's Last Name
Your answer
Gender
Please select one
Student's Date of Birth
MM
/
DD
/
YYYY
Parent/Guardian Name
Your answer
Parent/Guardian Email Address
Your answer
Are you interested in joining a committee of parents led by our Program Manager?
Street Address
Ex.123 Main Street, Apt 15
Your answer
Parent/Guardian Primary Phone Number
(123) 456-7890
Your answer
Parent Guardian Secondary Phone Number
(987) 654-3210
Your answer
Do you and/or your child(ren) live in Marcy Houses?
If "No," do you and/or your child(ren) live in a NYCHA housing development other than Marcy?
If "Yes," to the above, provide the name of the development here.
Your answer
Which category describes your annual household income?
How many members are a part of your household?
Child's Race/Ethnicity
Emergency Contact Name
This should be someone other than the parent/guardian listed previously.
Your answer
Emergency Contact Phone Number
(123) 456-7890
Your answer
Emergency Contact's Relationship to Student
Your answer
Does the student have any food allergies?
If yes, what food is your child allergic to?
(If no, leave blank)
Your answer
Are there any other medical conditions you think we need to be aware of?
Your answer
Uniform Size
How did you hear about us?
If you selected "Other" above, please explain.
Your answer
Please check the box below to signify your agreement with the KCTL Student Release Form and Liability Waiver: https://drive.google.com/file/d/0B0Vuk8XcPJqqUjBtSnhXZE1CdUE/view
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