TENNIS CAMP 2016 REGISTRATION FORM

TENNIS CAMP 2016
REGISTRATION FORM
ACADEMY SUMMER CAMP
3738 Northwood Avenue, Easton, PA 18045
Please fill out one form per child.
www.NorthwoodRFC.com | 610.258.2907
Name of Camper:__________________________________
Date of Birth:_____________________________________
Name of Parent: ___________________________________
Email: ___________________________________________
Home Address: ___________________________________________________________________________________________
Home Phone: ______________________ Cell Phone: ______________________
Work Phone:______________________
Camper Shirt Size (circle one): Youth small, medium or large. Or Adult small, medium, large or extra large
Level of experience: ________________________________
USTA National/Sectional Ranking:_________________
PRICING OPTIONS
HALF-DAY
FULL-DAY
(9 AM—12 PM) or (1 PM—4 PM)
(9 AM—4 PM)
Single class
$50
$90
4 day pass
$180 ($45 per day)
$320 ($80 per day)
8 day pass
$360 ($45 per day)
$640 ($80 per day)
12 day pass
$516 ($43 per day)
$936 ($78 per day)
16 day pass
$656 ($41 per day)
$1216 ($76 per day)
$995
$1780
NUMBER OF DAYS
Grand Slam Pass
Pay in full by May 31, 2016 to save $25 and receive a free camp t-shirt!
Passes may be used any day the summer camp is offered. Passes may only be used for summer camp.
You must reserve a spot in the camp 8 hours before the camp day begins. You may reserve a spot as far in
advance as you prefer. You may cancel up to 1 hour before start of the camp day.
 I understand that purchased camp days are forfeited if not used by August 18, 2016.
 I understand that I must reserve a spot in the camp for my child 8 hours before the start of the camp day.
Parent Signature: _______________________________________________
(Please fill out the back of this form)
Desk Staff only: Date:___________ Initials:__________ Discounts applied: $___________
TENNIS CAMP 2016
RELEASE FORM
3738 Northwood Avenue, Easton, PA 18045
www.NorthwoodRFC.com | 610.258.2907
Name of Camper:___________________________________________
Age: ________________
GENERAL: In registering my child as a participant in the 2016 Northwood Summer Tennis Camp, I understand my child assumes any and all risks which might be associated with its activities and waive
and release all rights and claims for damages which my child, heirs, executors, administrators, assigns, or I may have against Northwood Racquet & Fitness Club its director, coaches, or representatives, for any and all injuries or damages of any kind suffered as a result of participation in 2016
Northwood Summer Tennis Camp.
PHOTOGRAPHY: Northwood occasionally takes photographs for instruction and marketing purposes.
I authorize Northwood to take, use, publish, and reproduce photographs, moving pictures, of my
child for its teaching, documentation, or public relations.

Photographs are OK
Initial _______

No, thanks, I do NOT want any photos taken
Initial _______
MEDICAL: I, the undersigned, as Parent/Guardian of camper:_____________________, give my consent
for emergency first--aid/medical/surgical treatment of my child in the unlikely event that medical
attention may be necessary.
Does your child suffer from any allergies (food, insect stings, etc.) that could be problematic while
he/she is at camp? (Y / N ). If yes, please describe allergen, typical reaction, and treatment:
_________________________________________________________________________________________________
_________________________________________________________________________________________________
Physician’s Name:____________________________________
Phone:_______________________________
Insurance Provider:___________________________________
Policy No. ____________________________
Additional Emergency Contact Name and Phone: _______________________________________________
Signature of Parent/Guardian:_____________________________________
Date: _________________