Junior Program

First Name

Last Name

School Name

Date of Birth

Age

Sex Sex Male Female

Does your child have any medical conditions and or taking any medication that we should be aware of? Does your child have any medical conditions and or taking any medication that we should be aware of? Yes No

Parent/Guradian

Address

Contact Information

Registration Fee $10.00: Fee $15.00 per Month

I agree not to take any legal action against the Long Look Tennis & Education and their Coaches, Patrick & Carol Mitchell, for any illness or injury that your child might suffer as a consequence of their participation in the after school tennis program