FOR SPRING SESSION, 2012 ONLY

Name:___________________________________________________

If 17 or younger: ____Boy  ____Girl   Age:____  DOB:______________

Street Address:__________________________________________________________

City, State, Zip:__________________________________________________________

Phone:___________________________(home)______________________________(Office/Cell)

Email Address:________________________________________________________

Level:  ____Beginner  ____Low Intermediate  ____Intermediate  ____Advanced

Program name:________________________________________

Day & Time: __________________________________________(1st Choice)

Day & Time: __________________________________________(2nd Choice)

Day & Time: __________________________________________(3rd Choice)

Signature: ___________________________________________

Parent/legal guardian signature required for applicants under 18 years of age, allowing participation and waiving any claims that may result from injury as a result of tennis activity.

Classes missed for personal reasons (illness, vacations, etc) are lost.  Make-ups are NOT provided and no refunds or credits for such missed classes will be given.  Credit in the next session may be given for documented long-term illness or injury.  Registration will not be refunded or credit if you cancel after your class has been confirmed.

Important:- To participate in any of the above programs you must register and pay by:

Saturday March 31, 2012

PAYMENT INFORMATION-PLEASE PRINT

Payment method: ____ Check(s) enclosed (payable to The Racquets Club of Warren)  ___Visa  ___ MasterCard

Amount of payment (payment in full is required for registration)  $__________________

Name as it appears on credit card: _______________________________________________

Credit card billing address: _____________________________________________________

______________________________________________________

Card number:_______________________________________________________________

Exp Date____/____ CVV/CVC*_____

* This number is the last three digits printed in the signature area on the back of your card.

Card holders signature: _______________________________________________________