SPRING “QUICKSTART” PROGRAM REGISTRATION FORM For elementary age juniors 6-9 years old SPRING “QUICKSTART” PROGRAM Welcome to the Green Tree Spring "QUICKSTART" Program on line entry form. To enroll you child in our camps, please provide the information on the next pages. You must secure your camp reservation with a credit card. Step 1 of 4 - PARENT/GUARDIAN INFORMATION 25% Name* First Last Email* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Day Phone*Night Phone*Cell PhoneClick this box if you are a member of Green Tree Tennis Yes How many of your children will be attending this program?*123456How many of your children will be attending this program?*123456Child 1Child 1* First Name Last Name Child 1 Birth Date*Child 1 School*Child 1 Age*Child 1 MedicalPlease check if child has medical problems and/or taking medication Yes Child 2Child 2* First Name Last Name Child 2 Birth Date*Child 2 School*Child 2 Age*Child 2 MedicalPlease check if child has medical problems and/or taking medication Yes Child 3Child 3* First Name Last Name Child 3 Birth Date*Child 3 School*Child 3 Age*Child 3 MedicalPlease check if child has medical problems and/or taking medication Yes Child 4Child 4* First Name Last Name Child 4 Birth Date*Child 4 School*Child 4 Age*Child 4 MedicalPlease check if child has medical problems and/or taking medication Yes Child 5Child 5* First Name Last Name Child 5 Birth Date*Child 5 School*Child 5 Age*Child 5 MedicalPlease check if child has medical problems and/or taking medication Yes Child 6Child 6* First Name Last Name Child 6 Birth Date*Child 6 School*Child 6 Age*Child 6 MedicalPlease check if child has medical problems and/or taking medication Yes Sessions and PricingQUICKSTART TENNIS. Green Tree’s beginning and advanced beginning tennis program is for children who are elementary school age 6-9 years old.Please select HOW MANY sessions (Quantity):*1 Session2 Sessions3 SessionsThe member prices for “QUICKSTART” program.Please select HOW MANY sessions (Quantity):*1 Session2 Sessions3 SessionsThe non-member prices for “QUICKSTART” program.Price for 1 session per child (member pricing)Price for 2 sessions per child (member pricing)Price for 3 sessions per child (member pricing)Price for 1 session per child (non-member pricing)Price for 2 sessions per child (non-member pricing)Price for 3 sessions per child (non-member pricing)This field is hidden when viewing the formTotal for One ChildThis field is hidden when viewing the formTotal for All ChildrenSessions & DatesPlease select Saturday or Sunday Saturday - 10:00 - 11:00 am Sunday - 1:00 – 2:00 pm Select WHICH SessionsThis registration is for Saturday morning "QUICKSTART" Program. Please select WHICH sessions your child(ren) would like to attend. This selection is for all children your are registering. NOTE: Please make sure that the NUMBER of sessions you have signed up for, matches WHICH weekly sessions you mark . For example: If you mark NUMBER of sessions as two, be sure that you have marked two session weeks. Session 1: Feb. 7,14,21,28 Session 2: March 7,14,21,28 Session 3: April 11,18,25 May 2 (No meeting Saturday April 4) Select Which SessionsThis registration is for Sunday afternoon "QUICKSTART" Program. Please select WHICH sessions your child(ren) would like to attend. This selection is for all children your are registering. NOTE: Please make sure that the NUMBER of sessions you have signed up for, matches WHICH weekly sessions you mark . For example: If you mark NUMBER of sessions as two, be sure that you have marked two session weeks. Session 1: Feb. 1,8,15,22 Session 2: March 8,15,22,29 Session 3: April 12,19, April 26, May 3 (No meeting Sunday April 5) Total for All Children Price: $0.00 Sibling Discount Price: $0.00 Total after Sibling DiscountProcessing Fee Price: $0.00 A non-refundable processing fee of $10/child is added to your registration.3% Credit Card Fee Price: $0.00 Total Camp Price $0.00 Waiver InformationRelease of Liability*By signing this Medical Release and Liability Form, I expressly warrant and assume all risks to the child named above participating in the activities, whether such risks are known or unknown to me at this time. I further release Green Tree Tennis Club, its owners, employees, staff, volunteers and agents from any claim that my child may have or that I may have against them as a result of injury or illness incurred during the course of participation in these activities. I further agree to indemnify and hold harmless Green Tree Tennis Club, its owners, employees, staff, volunteers and agents from any and all claims arising from my participation in its activities and programs, or as a result of injury or illness of my child during such activities. I accept First Aid and Emergency Medical Treatment*I recognize that there may be occasions where the child named above may be in need of first aid or emergency medical treatment as a result of an accident, illness, or other health condition or injury. I do hereby give permission for agents of Green Tree Tennis Club to seek and secure any needed medical attention or treatment for the child named above including hospitalization, if in the agent’s opinion such need arises. In doing so, I agree to pay all fees and costs arising from this action to obtain medical treatment. I accept CREDIT CARD CHARGES*My credit card will be charged the above amount. I accept CREDIT CARD AUTHORIZATION*FOR VISA, MC, AMEX or Discover credit or debit cards: I authorize a representative of Green Tree Tennis Club to charge any unpaid tennis/sports camp, snack bar and/or early or late drop off balances for the child named above to my MC, VISA, AMEX or Discover credit or debit card. I have read and agree to all Green Tree FAQ/Policies, to include the club’s refund policies, regarding Junior Tennis Programs, Spring Break Camps, Summer Sports and Tennis Camps to include Combo and Summer Swim Lesson Programs. I Authorize Please complete the information below and press the button only once. Pressing the button multiple times will charge your credit card multiple times.Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Expiration Date Security Code Cardholder Name
