Youth Registration – Gaines Park Tennis Association

YOUTH REGISTRATION FORM

Child's Middle Initial

Child's Date of Birth

Child's Gender

Female Male Prefer Not To Say

Does your child have any special needs?

Yes No

If Yes, please explain your child's special needs

Does your child take any medication(s)?

Yes No

If Yes, please list medication(s)

Does your child have any allergies?

Yes No

If Yes, please list allergies

Primary Parent/ Guardian First Name

Primary Parent/ Guardian Last Name

Primary Parent/ Guardian Gender

Female Male Prefer Not To Say

Primary Parent/ Guardian Email

Would you like to join our mailing list?

Yes No

Primary Home Street Address

Which type is Primary # ?

Mobile Home

Join GPTA Text Alerts

Opt In Opt Out

Secondary Parent/ Guardian Instructions

Secondary Parent/ Guardian First Name

Secondary Parent/ Guardian Last Name

Secondary Parent/ Guardian Gender

Female Male Prefer Not To Say

Secondary Person Phone #

EMERGENCY TELEPHONE #

Select which session you are registering for.

Session 3 - June 12 - August 5, 2023 Session 4 - August 14 - October 7, 2023 Session 5 - October 23 - December 16, 2023

Select which clinic you are registering for.

Wee Warriors Red Ballers Orange Ballers Juniors

Select which clinic day(s) you will be attending.

By checking the box below I affirm that I agree with the statement below

I understand and accept that there is a $25 fee per Eight (8) week session

Opt In

By signing up via text, you agree to receive recurring automated marketing messages, including cart reminders, at the phone number provided. Consent is not a condition of purchase. Reply STOP to unsubscribe. Reply HELP for help. Message frequency varies. Msg & data rates may apply

Form of Payment

Electronic Check Cash

In consideration of being permitted to participate in clinics, lessons, leagues and programs, I hereby release, waive, and discharge the City of West Palm Beach, its agents, employees, volunteers, and Gaines Park Tennis Association from all liability for all injury, loss or damage, and any claim of damage to my person or property during my participation. It is understood that I may be photographed while at the Tennis Center and the photographs may be used in official City of West Palm Beach publications was well as official publications by Gaines Park Tennis Association. It is further understood that any false information provided for in this registration form will be cause for immediate termination based on participation safety and ratios.