REGISTRATION FORM (FOR ANY PROGRAM )PROGRAM_______________________________________

NAME___________________________________________________________DATE OF BIRTH___________________

ADDRESS________________________________________CITY,STATE,ZIP__________________________________

HOME PHONE_________________WORK 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.

____CHECK HERE THAT WE HAVE YOUR PERMISSION TO PUBLISH PHOTOS ON WEBSITE AND/OR IN PRINT.

SIGNATURE__________________________________________________________DATE_______________________

(PARENT SIGNATURE (IF UNDER AGE 18)

OTHER PHONES:

print and mail this form with check to Edmond Racquet Club

.   425 Lilac Dr

  Edmond, OK   73034