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Jimmie ‘Doc’ Horne
Celebrating Black History Month
Ways to Get Involved
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CONTACT US
Menu
HOME
Schedule of Events
2023 Clinics Schedule
PROGRAMS
GPTA Clinic Programs
Training Resources
Baselines & Books
Register
Youth Registration
Adult Registration
PARTNERS
ABOUT US
Board of Directors
Jimmie ‘Doc’ Horne
Celebrating Black History Month
Ways to Get Involved
Donate
Volunteer
CONTACT US
YOUTH REGISTRATION FORM
Child's First Name
Child's Middle Initial
Child's Last Name
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
City
State
Zip code
Primary #
Which type is Primary # ?
Mobile
Home
Join GPTA Text Alerts
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Alternate #
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 CONTACT
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.
Wee Warriors Mondays 4:00PM - 4:30PM
Wee Warriors Wednesdays 4:00PM - 4:30PM
Wee Warriors Saturdays 8:30AM - 9:00AM
Red Ballers Mondays 4:40PM - 5:40PM
Red Ballers Wednesdays 4:40PM - 5:40PM
Red Ballers Saturdays 9:05AM - 10:05AM
Orange Ballers Mondays 5:45PM - 6:45PM
Orange Ballers Wednesdays 5:45PM - 6:45PM
Orange Ballers Saturdays 8:30AM - 9:30AM
Juniors Mondays 4:40PM - 5:40PM
Juniors Wednesdays 4:40PM - 5:40PM
Juniors Saturdays 10:00AM - 11:00AM
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
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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.
Signature
Date
SUBMIT REGISTRATION
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