Student Information

First Name *	Last Name *	Date of Birth *	Gender

Tennis Experience	Medical Conditions, Allergies or Current Medications

Parent / Guardian Information

I certify that the information provided is accurate. *
I understand that tennis is a physical activity and that participation involves inherent risks of injury.*
I release and hold harmless the program, its volunteers, instructors, and facility from liability for injuries arising from participation.*
I authorize emergency medical treatment if I cannot be reached in an emergency.*
I give permission for my child to participate in the program.*
I give permission for photos and videos of my child to be used for the program's website, social media, and promotional materials.
I have read and understand this waiver. I agree to the terms and give permission for my child to participate in Rally for Change.*


Parent/Guardian Name *	Date


Signature