Julie Ditty Qualls Tennis Clinic Registration Form
Clinic Dates: June 2-6, June 9-13
Times:
Ages 7-11: 9-10am
Ages 12-18: 10-11am
Location: Ashland Tennis Center
Contact: 606-922-9922
**if interested in being an instructor, please fill out this form and contact Jack Ditty MD at jackfdittymd@gmail.com

**T-shirts will be available for purchase for $20 at the clinics

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Name *
Age *
Phone Number *
Email *
Address *
Please select if you will be attending as a participant or an instructor. *
Emergency Contact Name *
Emergency Contact Phone Number *
What days will you attend? If attending all days, select “will be there every day”. If not, please select which days your child will attend. *
Required
I have read the release, and I accept and agree to the terms of the release required to participate in the clinic, and acknowledge that by checking this box, this constitutes my electronic signature.          Link to Waiver:https://docs.google.com/document/d/1a42zCkl7bPb4mtaw-MwjFqJTzePjuW400H3d5R3MUIM/edit?usp=sharing
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