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Swim Clinic Registration

    Swimmer's Name *
    DOB *
    Parent/Guardian Name(s) *
    Phone *
    Email *
    Parent/Guardian Name(s)
    Phone
    Email
    Address *
    Ages 6-9 | Tuesday/Thursday/Friday | 4:00 p – 5:00 p
    Ages 9-12 | Tuesday/Thursday/Friday | 5:00 p – 6:00 p
    Ages 12+ | Tuesday/Thursday/Friday | 6:00 p – 7:00 p

    Ages 6-9Ages 9-12Ages 12+
    Continue enrollment month to month?
    yesno
    Are you currently an RAC Member?

    yesno
    Payment Method
    Total Cost/Mo: $145 (August Registration is $75, start date 8/17)
    Charge to Member Account.Contact me for payment information.
    Emergency Contact 1*
    Phone *
    Emergency Contact 2
    Phone
    Allergies
    Medications to be administered in case of emergency
    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.

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

    all agreements must be checked

    Parent/Guardian Signature *
    Date *