Registration form

REGISTRATION FORM

PROGRAM NAME & DATE___________________________________________________

NAME___________________________________________________________DATE OF BIRTH___________________

ADDRESS________________________________________CITY,STATE,ZIP__________________________________

HOME PHONE_________________CELL PHONE____________EMERGENCY CONTACT______________________

I HEREBY AUTHORIZE THE DIRECTORS OF EDMOND RACQUET CLUB TO ACT FOR ME OR MY CHILD ACCORDING TO THEIR BEST JUDGMENT IN ANY EMERGENCY INCLUDING MEDICAL ATTENTION. FURTHERMORE, I HEREBY RELEASE EDMOND RACQUET CLUB AND ITS AGENTS FROM ANY ACTION THAT MAY ARISE DURING OR AS A RESULT OF ANY ACTIVITIES. WE HAVE YOUR PERMISSION TO PUBLISH PHOTOS ON WEBSITE AND/OR IN PRINT.

SIGNATURE__________________________________________________________DATE_______________________

(PARENT SIGNATURE (IF UNDER AGE 18)

EMAIL:____________________________________________________OTHER PHONES:_______________________

HOW DID YOU HEAR ABOUT US ?___________________________________________________________________

________________________________________________________________________________________________

Print this form and mail with check to:

Edmond Racquet Club

425 Lilac Dr

Edmond, OK 73034