Junior Tennis Registration – Rollingwood Athletic Club

Player Name *

DOB *

Phone *

Email *

Address *

Select Program

Tots Program: Mon/Wed/Sun
N/A1 day per week $852 days per week $1553 days per week $220

Beginner/Intermediate Program: Mon/Wed/Fri
N/A2 days per week $280*Add-on Sundays $60

Were you enrolled in the RAC Fall Junior Tennis program?
*Fall Participants receive a 25% discount on regular program fees. (Beginner/Intermediate only)
yesno

Payment Method

Charge to Member Account.Contact me for payment information.

Parent/Guardian Name(s) *

Phone *

Email *

Parent/Guardian Name(s)

Phone

Emergency Contact 1*

Phone *

Emergency Contact 2

Phone

Allergies

Medications to be administered in case of emergency

Are you currently an RAC Member?
yesno

Due to COVID-19 Rollingwood asks that at least one member of the family is a RAC member. This status allows the players to use the courts at the specified program times, practice times, organized match play on Fridays or as instructed by their coach. The membership will be a month to month membership requiring 30 days written notice of cancellation emailed to [email protected]. The dues and monthly tennis program payment will be required through billing on the first business day of the month with the payment information provided above. Questions about membership types, contact us. 916-988-1727

Release, Waiver of Liability & Consent for Medical Treatment

In the event of illness or injury arising out of my child’s participation in RAC Junior Tennis Program, I give consent and authorization for (1) the administration of emergency first aid care and treatment at the scene of an emergency by employee at RAC, or (2) the administration of any treatment deemed necessary by a licensed physician, and (3) the transfer to a hospital reasonably accessible.

I understand and agree that my child’s participation in the RAC Junior Tennis Program is voluntary. I further understand and agree that participation in the RAC Junior Tennis Program is at my child’s or my own risk and that Rollingwood Athletic Club is not responsible for any incidents, injuries, or loss of property that may occur.

In the event of an emergency if I cannot be reached, I give permissions to RAC staff to obtain medical treatment for my child. I hereby release RAC, its staff and employees from claims of damages while participation in RACs Junior Tennis Program. I have carefully read this entire consent for Medical Treatment and Waiver of Liability and I fully understand its contents.

I have signed this form of my own free will and I agree to be legally bound to it.

By signing and initialing below, I agree to the following terms and conditions

Behavior Policy: Student Members must abide by all rules of RAC. Each member must behave appropriately towards other members and staff at all times. Inappropriate behavior may result in dismissal from the Junior Tennis Program without a refund.

Photography/Video Policy: I give Rollingwood Athletic Club permission to print and publish my child(s) picture for promotional purposes. I understand that I will not receive compensation for my child(s) picture/video.

all agreements must be checked

Parent/Guardian Signature *

Date *