Parent or Guardian Name *
Parent or Guardian Name
Phone 1 *
Phone 1
Parent or Gaurdian's Name
Parent or Gaurdian's Name
Phone 2
Phone 2
Child's Name 1 *
Child's Name 1
Child's Birthday 1
Child's Birthday 1
Child's Name 2
Child's Name 2
Child's Birthday 2
Child's Birthday 2
Child's Name 3
Child's Name 3
Child's Birthday 3
Child's Birthday 3
Address *
Address
Authorized for Pickup
Authorized for Pickup
Staff are authorized to release children ONLY to Parents/Gaurdians listed above and individuals added here. Children will NOT be permitted to leave the camp with anyone not listed. All authorized individuals must be at least 18 years old and will be required to show photo identification daily and sign the child out daily.
Authorized for Pickup Phone
Authorized for Pickup Phone
Authorized for Pickup 2
Authorized for Pickup 2
Authorized for Pickup Phone 2
Authorized for Pickup Phone 2
Please Note any Special Drop Off Pick Up Instructions Here. Example - Child is able to Check-In and Out on their own, In case of Emergency are there additional adults authorized for Pickup or any adults that the child CANNOT be released to?
List all health concerns including Medications, Allergies, Physical Limitations, Mental or Emotional Issues, and whether your child carries an EpiPen or inhaler. List your child's Physician and Insurance Information. If you would like us to keep your child's Physician physical evaluation form on file in case of emergency, email a copy to admin@tennisworldnyc.com.
Authorization and Consent *
A. I recognize the importance of following staff instructions regarding training and rules and agree to obey such instructions. B. I certify that all participants are in good physical condition, sufficient to use the facilities and participate in the program. I recognize that tennis, sports conditioning and physical activity, by its very nature, carries with it certain dangers and risks that cannot be eliminated regardless of the care taken to avoid injuries; that although activities may not be strenuous, injuries or medical complications may occur; that balance and physical coordination may affect the occurrence of accidents or falls; that the participant should ask about other potential hazards and recommended precautions; and that, in addition to physical activity, the participant may be subjected to risks associated with traveling in vehicles. I knowingly assume all risks associated with participation in the program. C. Tennis World, LLC and Marina's Tennis Company LLC are not responsible for belongings which may be broken, missing or stolen. D. I give permission for transportation by car, bus or subway in the event of emergency or inclement weather, or if registered for Pick Up Transportation or participation in a Field Trip. E. I hereby authorize any medical treatment deemed necessary in the event of any injury to the participant while participating in any activity. I have appropriate insurance, or, if not, I agree to pay all costs of medical services incurred on my behalf. F. I understand that video production and/or photography may be conducted during the program. I fully and irrevocably grant to Tennis World, LLC, and Marina's Tennis Company LLC, its agents, and its designees, the unqualified right and permission in perpetuity, to reproduce, copyright, publish, broadcast or otherwise use my name, image, likeness, voice, biography or other identification in any and all media now known or hereafter devised, for any commercial or non-commercial purpose at the sole discretion of Tennis World, LLC and Marina's Tennis Company LLC. I waive any right, claim or interest in such use and understand that there will be no compensation or other financial remuneration. G. As a further condition of participation in the program, and to the maximum extent permitted by law, I, on behalf of myself, the minors listed, my executors, administrators, heirs, personal representatives, successors and assigns, release, waive, hold harmless and discharge Tennis World, LLC, Marina's Tennis Company LLC, and the City of New York with its officials and employees, and others in any manner connected with any such program, event and/or other related activities, including, without limitation, the employees, officers, directors, agents and representatives of Tennis World, LLC, and Marina's Tennis Company LLC from any and all claims and demands of every kind, nature and character for any losses, injuries or damages that I may sustain, directly or indirectly, arising out of or related to traveling to or from or participating in any program, event and/or any other related activities on any legal theory whatsoever, regardless of whether caused by the negligence of the Released Parties (the “Released Claims”). To the maximum extent permitted by law, I hereby covenant and agree that I will not bring or be a party to any legal action or claim against the Released Parties for any reason based on any of the Released Claims. I agree to indemnify and hold harmless each of the Released Parties from any and all liabilities, claims, actions, damages, expenses, losses and costs of any kind (including, without limitation, attorneys’ fees and costs) caused by or arising out of my participation in any program, event and/or related activities, including, without limitation, my breach of any provision of this Consent and Wavier and any damages caused by me. Myself, Tennis World, LLC and Marina's Tennis Company LLC irrevocably submit to the exclusive jurisdiction of the federal or state courts in New York, New York in the event of any dispute, claim or action.