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AMP Junior Star Tennis Academy
Summer Enrollment Form
Name __________________________ Age __ Date of Birth __________
Home Phone # ___________________ Mobile Phone # _______________
Work Phone # _______________Email Address _____________________
School Attending _________________________ Grade Level __________
Parents _____________________________________________________
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
(8:30-9:30am) (9:30-11:30am)
(9:30-12:30pm)
Please circle the boxes for the sessons your child plans to attend:
Session I June 11 - 15 II June 18 - 22 III June 25 - 29
IV July 02 - 06 V July 09 - 13 VI July 16 - 20
VIII July 30 - 03 IX Aug 06 - 10 X Aug 13 - 17
Please circle the days your child plans to attend:
Monday Tuesday Wednesday Thursday Friday
Waiver Liability
We, (I) the parent/guardian give permission for __________________ to participate in the AMPTENNIS, LLC. tennis program(s). We, (I) hereby waive and release AMPTENNIS, LLC., 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
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