Player's Name *

First Name

Last Name

Player's Date of Birth *

MM

DD

YYYY

Primary Guardian's Name *

First Name

Last Name

Primary Guardian's Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Primary Guardian's Phone *

(###)

###

####

Text Messaging Okay?

Check this box if it is okay for Tennis Galaxy to send a text via the phone number above. Your service provider may charge for text messaging.

Question 2 *

Classes are held at specific times on specific days. Can you be sure you or your player will have transportation to and from the classes?

Yes

No

Question 4 *

The scholarship is intended for players who wouldn’t be able to join tennis classes without this support. Do you agree with this intent and think it describes your player’s situation?

Yes

No

Question 6 *

In order to participate in Tennis Galaxy programs, each player and/or guardian is required to agree to a release of liability, authorization for emergency medical treatment and a media consent. Are you willing to fully review the forms and ensure you understand their contents before signing that you agree to the terms?

Yes

No

Question 7 *

A goal of the scholarship program is to make a player’s interest in tennis and opportunities to play tennis sustainable. If you or your player receive a scholarship, are you willing at the end of the funding period to share with us feedback on how your player could continue in tennis, with or without additional scholarship funding?

Yes

No

Waiver *

I understand I will need to sign a waiver of liability to participate or allow my child to participate in this program. I agree that, if accepted into a class or lesson, I must sign the waiver prior to participation by me or my child.