AMP Junior Star Tennis Academy
 Enrollment Form

Name __________________________ Age __ Date of Birth  __________

Home Phone # ___________________ Mobile Phone # _______________

Work Phone # _______________Email Address _____________________

School Attending _________________________ Grade Level __________

Mailing Address _______________________________________________

City ___________ Zip Code ________ Site Location __________________

Please circle the class your child plans to attend:

Twinkle Stars    Tiny Stars      Future Stars     Superstars      Tournament Stars

Monday       Tuesday       Wednesday        Thursday        Friday         Saturday

Waiver Liability

          We, (I) the parent/guardian give permission for __________________ to participate in the AMP, Inc. tennis program(s). We, (I) hereby waive and release AMP, Inc., and its staff or instructors from any liability, injury or illness incurred while participating in the programs.  I have no knowledge of any physical impairment that would be affected by my child’s participation in the programs.

___________________________________________            Signature

___________________________________________            Printed Name

_____________________                                                      Date

Cut and paste into your word processor edit your information and email as an attachment to chad@amptennis.com

                                Or

Print and mail back to AMP, Inc.,    PO Box 991    Concord, NC 28026-0991