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EDGEWOOD JUNIOR TENNIS

2012 Junior Tennis Clinics Registration Form

*Required Fields

Please enroll my child(ren) in the following clinics
Child 1 Name*
Date of birth*
Age*
	Tiny tots
	Beginner
	Intermediate
	Week 1 June 18 thru 22 Max Schmerin 5 Sessions $75
	Week 2 June 25 thru June 29 Max Schmerin 5 Sessions $75
	Week 3 July 9 thru 13 Max Schmerin 4 Sessions $75
	Week 4 July 16 thru 20 Max Schmerin 5 Sessions $75
	Week 5 July 23 thru 27 Max Schmerin 5 Sessions $75

Child 2 Name
Date of birth
Age
	Tiny tots
	Beginner
	Intermediate
	Week 1 June 18 thru 22 Max Schmerin 5 Sessions $75
	Week 2 June 25 thru June 29 Max Schmerin 5 Sessions $75
	Week 3 July 9 thru 13 Max Schmerin 4 Sessions $75
	Week 4 July 16 thru 20 Max Schmerin 5 Sessions $75
	Week 5 July 18 thru 22 Max Schmerin 5 Sessions $75

Child 3 Name
Date of birth*
Age*
	Tiny tots
	Beginner
	Intermediate
	Week 1 June 18 thru 22 Max Schmerin 5 Sessions $75
	Week 2 June 25 thru June 29 Max Schmerin 5 Sessions $75
	Week 3 July 9 thru 13 Max Schmerin 4 Sessions $75
	Week 4 July 16 thru 20 Max Schmerin 5 Sessions $75
	Week 5 July 18 thru 22 Max Schmerin 5 Sessions $75

MEMBER INFORMATION
Name*
Level of Membership*
Street*
City*
State*
Zip*
Email Address*
Phone*

PAYMENT
Name on card*
Credit Card Number*
Exp. Date valid thru 10.31.2012*
Card type*

Credit Card Billing Address (only if different than listed above)
Street Address
City
State
Zip

	As the credit card holder, I hereby authorize The Edgewood Club, to charge my credit card for the selected membership category and future fees verbally approved by me. *