Madison Rising Stars Registration and Release Form Summer 2007
(Revised
Please
complete a separate form for each child who wants to participate. ($10 each)
[Include a check made payable to the Greater Madison Tennis Association (GMTA)]
Mail to Jack O’Meara, 2420 Gregory St. Madison, WI 53711
Questions call Jack 233-5495 or e-mail him at jack@omearapublicaffairs.com.
Name
_______________________________________ Age (on Jun 1) _________
Address
_____________________________________ Birth date _______________
City
__________________ Zip code _____________ Phone ___________________
Email
address _________________________________________________________
School
for 2007-8 year ___________________________________ Grade ________
Parent
name(s) ___________________________________________________________
Additional phone or email
information (most communication is by e-mail):
________________________________________________________________________
Describe any tennis
lessons/activities the applicant participated in during the last year.
______________________________________________________________________________
The Rising Stars staff assumes that parents
will be present during the tennis practice. If there were to be an injury and I am not in
attendance at the practice, I would want the Rising Stars staff to call me at
_________________________________________ or to have another parent,
____________________________________ to act for me.
By registering my child
for the Rising Stars Tennis program, I hereby agree and understand:
1.
That the Rising Stars Tennis Program is not covered
by accident insurance.
2.
That I and my child(ren) will adhere to the Tennis Program and rules and procedures.
3.
That no liability for any injury is assumed or
implied by the MMSD, MSCR, Madison Park District, Greater Madison Tennis
Association, Wisconsin Tennis Association, Coaches, Volunteers, Parents, or
other participants.
4.
That the Rising Stars staff may take photos of my
child(ren) that may be used for Rising Stars,
Wisconsin Tennis Association or Wisconsin Tennis Foundation brochures or
advertising flyers.
Applicant
Parent Signature_________________________________ Date ___________
Grant
funds help cover equipment and instructors but not pizza, prizes or t-shirts if
we want to get new ones. We are asking
that participating families make an extra donation if they can, in addition to
the program fee. This is strictly a
donation and is not required.
Program
fee enclosed: $10 Donation:
_______ Total amount
enclosed: _______
While
this program is open to all kids, special consideration is given to minority
and/or low-income players. Please
describe the applicant’s qualifications for special consideration, if any.
___________________________________________________________