Kensington Gardens Lawn Tennis Club
Junior and KENSI Hot Shots Registration Form 2018-2019
Family Name *
Your answer
First Name *
Your answer
Gender *
Required
Date of Birth *
MM
/
DD
/
YYYY
Age as at 1/01/19 *
1/01/18
Your answer
Tennis SA Number (if played before):
Your answer
Years Played:
experience level, beginner,some tennis etc.
Your answer
Parent(s) Name: *
Your answer
Address: *
Your answer
Contact Phone Number *
Your answer
Mobile Phone Number
Your answer
Email Address *
Your answer
Permissions *
PHOTOGRAPH PERMISSION I give permission for club members or officials to take tennis photographs of the child I am registering as a club member and for those photographs to be used for promotion of the Kensington Gardens Lawn Tennis Club, including on the club website and club Facebook page
Required
MEDICAL CONSENT *
In the event of my child being injured and requiring medical attention an ambulance may be called and I accept responsibility for any medical expenses incurred.
Required
MEDICAL INFORMATION *
Any significant conditions or allergies?
Required
Ambulance Cover *
Required
Doctors Names *
Your answer
Doctors Contact Number *
Your answer
Emergency Contact Name and Number *
Your answer
Fees *
All fees must be paid prior to the start of the school term. Cash/Cheque No Credit Card Facilities
I agree to accept responsibility for payment of my child’s fees as detailed above *
Required
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