Junior Program Custom Payment

  • Junior Program Custom Payment Form

     
  • Please enter a number from 5 to 18.
  • Parent Information

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  • Price: $1.00 Quantity:
    Enter the dollar amount and press the Enter key
  • $0.00
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  • Medical Authorization & Release

  • Date Format: MM slash DD slash YYYY
    By dating above & signing below, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the 4 Star Tennis Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.
  • Date Format: MM slash DD slash YYYY
    By dating above & signing below, I agree to hold the 4 Star Tennis Academy and Potomac Swim & Tennis Acdemy harmless for injury or loss that may occur as a result of my participation in 4 Star activities.
    I give permission for photos of my child participating in 4 Star Tennis at Bullis programs to be taken and used for the 4 Star Tennis Website and/or Facebook page. We understand that if students are identified, only their first names will be used.