Madison Rising Stars Registration and Release Form Summer 2009

To apply for the 2009 summer session, complete the application and release form, attach a

check for $15 (plus any donation if desired).  Make check out to GMTA.  Your check will

not be cashed until you are notified your child is accepted into the program.  Mail the

application, release and check to Madison Rising Stars Tennis, P.O. Box 45717, Madison,

WI 53744-5717.

Questions?  E-mail Richard at richard@dermisoft.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: $15 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. ___________________________________________________________