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                     2017 Registration Form for Medford Summer Tennis Clinic
                 (*Please visit the Schedule link for availability before sending in the registration form)

    NAME OF CHILD:________________________________________________________________
    DATE OF BIRTH:_________________________________________________________________
    PARENTS/GUARDIANS NAMES:  ___________________________________________________



    Emergency Contact:________________________________________________________

    Emergency Contact phone:__________________________________________________

    SESSION: (please circle one)                    SESSION 1                                 SESSION 2
                                                                (July 10- July 21)                        (July 24- August 4)

    AGE GROUP & CLASS START TIME:     5-6 (9:00-10:00)                                 7-9 (10:00-11:00)           (please circle one)           
                                                                 10-13 (11:30-12:30)   


    TENNIS EXPERIENCE OF CHILD:              never played                     played a little
          (please circle one)

                                                                      know basic strokes           have played a match  

    ANY HEALTH/PHYSICAL ISSUES: (if none, please write none)__________________________


    PLEASE READ AND SIGN BELOW:   I release and hold harmless Medford Tennis Clinic and all         personnel thereof, from all liability resulting from personal injury or loss to my child.

    Parent signature___________________________________________Date____________

​        Check if you give permission for your child's photos to be used on our website and brochures.      
    Print and send this registration form with a check or money order.
    MAKE PAYABLE TO:   James Dickens
    MAIL TO:  Medford Summer Tennis Clinic, 70 Wright Street, Stoneham, MA  02180.     
     *You will receive an email or phone confirmation, once the registration is processed.  

    If you wouldn't mind, could you please tell us how you heard about the clinic: