Poughkeepsie Tennis Club Academy 2019
We're so excited to have you at PTC this summer! The Academy is for kids ages 10-16.

Please note a few things: by filling out this form and registering for Summer Camp, I, the undersigned, for ourselves, our heirs, executors, and administrator, wave, release and forever discharge Poughkeepsie Tennis Club (PTC) and its staff, officers, employees, representatives, and assign any and all liability claims, demands, actions and causes of actions whatsoever arising out of or related to any loss, personal injury or property damage that may be sustained or occur during participation of activities while at camp. I hereby authorize the staff of the PTC to act for me according to their best judgment in any emergency requiring medical attention. I have no knowledge of any physical impairment that would be affected by the above named child’s participation in the camp.This admits all qualified applications without regard to disability, race, color, religion, national or ethnic origin. I also grant to PTC, its representatives and employees the right to take photographs of my child in connection with using the PTC. I authorize PTC, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that PTC may use such photographs of my child without my child’s name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and Web content.

If you have any questions, please email us at poktenniscamp@gmail.com

Email address *
Name Of Attending Child *
Your answer
Child's Date of Birth *
MM
/
DD
/
YYYY
Age of Attending Child as of July 1, 2019 *
Your answer
Pick Your Session(s) *
Required
Member/Non-Member *
Preferred Payment Method *
Member Number
Your answer
T-shirt Size of Attending Child *
Level of Tennis Play *
Parent/Guardian Name *
Your answer
Parent/Guardian Cell Phone Number *
Your answer
Emergency Contact - Name *
Your answer
Emergency Contact - Relationship to Child *
Your answer
Emergency Contact - Cell Phone Number *
Your answer
Health Insurance Carrier *
Your answer
Policy Holder Name *
Your answer
Policy Number *
Your answer
Allergies/Medications *
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service