Musselburgh Tennis Club – Coached Activity Registration Form
Class:
Mini Red
/
Mini Orange
/
Mini Green
/
Junior
/
Tennis Express
PARTICPANT DETAILS
Name: ...................................................
Age: ..........
DOB: .....................
School: ..................................................
School Year: ..............
Parent/Guardian Name: .........................................................
Mobile Tel: ............................................
Home Tel: .....................................
E-mail: ...........................................................................
Address: ...........................................................................................................................................
Postcode: ........................................
Emergency Contact Name: .......................................................
Relationship: ...............................
Contact Number: .................................................
Musselburgh Tennis Club may contact you in connection with news and events related to the club. Your details will not be
passed onto a third party. If you do not wish to receive these communications please tick here □
MEDICAL CONDITIONS (This information will be kept confidential)
Does your child suffer from any relevant allergies, illnesses, medical conditions?
.........................................................................................................................................................
Does your child receive any medication?
.........................................................................................................................................................
Doctors Surgery: ...................................................................... Contact: ..........................................
Do you give permission for your child to receive medical assistance in an emergency situation?
Yes □
No □
Does your child have any additional support needs and/or is registered disabled? (If yes, please detail below.)
.........................................................................................................................................................
PHOTOGRAPHY PERMISSION - Musselburgh Tennis Club may wish to take photographs of your / your child’s coached activity
which may be used on the website or for promotional and publicity purposes? Do you give consent to your / your child’s
photograph being taken? Yes □ No □
GUIDANCE NOTES
- We recommend participants bring a sealed bottle of water to class.
- Due to the nature of the activity there may be a risk of personal accident or injury to participants.
- Parents/Guardians are responsible for the collection of their child at the end of each session.
- Musselburgh Tennis Club reserve the right to withdraw a participant from a coached session if the participant is misbehaving
or not using the equipment or facility in an appropriate and responsible manner.
I UNDERSTAND THE NATURE OF THE ACTIVITY TO BE UNDERTAKEN AND CONSIDER I AM/MY CHILD/CHILDREN IS/ARE FIT TO
TAKE PART. I HAVE READ AND AGREE TO ADHERE TO THE STATEMENTS ABOVE.
Signed: ................................................................................................................ Date: .....................................................