DONALD VANBLAKE TENNIS & EDUCATION FOUNDATION
(DVBTEF)
(formerly P.A.Y.D.T.A.)
Dear Parents and Friends,
The Donald Van Blake Tennis & Education Foundation (DVBTEF) is now accepting
applications for its 2011 Summer Junior Tennis Program.
The clinic will be held at the Donald Van Blake Tennis Complex on Randolph Road in
Plainfield. The program will start on Monday, June 27th and end on Friday, August 5th. Five
days per week for weeks, Monday thru Friday (excluding July 4th to observe Independence Day)
The cost of the program is $90.00.
Students will be assigned to a session based on their level of ability. The time of each
session is as following:
Session 1
(Beginner/Advanced Beginner players)
4:00 PM-5:30 PM
Session 2
(Intermediate/Advanced players)
5:30 PM-7:00 PM
Please complete and return the application (on back) along with $90.00 (by money order
or check payable to: DVBTEF) no later then June 23rd.
On-site registration is also available and will be held on Monday, June 27th at the courts.
DVBTEF
Attn: Sandy Lindsay
P O Box 621
Plainfield, NJ 07060
If you have any questions, please contact me at (908) 883-1113.
Sincerely,
Sandy Lindsay
Chairperson, Junior Development Program
PLEASE NOTE:
The head tennis instructor will be the sole person to assign students to
ability groups. Your compliance and cooperation will be greatly appreciated.
DONALD VANBLAKE TENNIS & EDUCATION FOUNDATION
(DVBTEF)
(formerly P.A.Y.D.T.A.)
P.O. Box 621
Plainfield, NJ 07060
(attention: Sandy Lindsay)
SUMMER EVENNING JUNIOR TENNIS PROGRAM 2011
APPLICATION
YOUTH’S NAME
____________________________________________________________
(Please print clearly)
ADDRESS _______________________________ _______________________ ____
Street
City
AGE ___________
State
______
Zip Code
BIRTHDATE ______________________
TELEPHONE ______________________________________________
PARENT/GUARDIAN __________________________________________________________
EMAIL of PARENT/GUARDIAN _________________________________________________
In case of an emergency, please contact:
______________________________________________________________________________
Name
Health concerns
Telephone # (cell / work)
________
No
________________________________________________________________________
Yes (Please include)
Parent/Guardian Authorization
I do hereby give my consent for my child to participate in the Donald Van Blake Tennis & Education
Foundation Junior Summer Tennis Program. I do hereby release Plainfield Board of Education, DVBTEF,
its officers, directors, members, volunteers, agents, advisors and sponsor(s) from any and all liability in
connection with his/her play or transportation related thereto. DVBTEF is hereby given my consent to allow
the administration of emergency treatment to my child if needed. Photographs, videotapes, and audio
recordings of the participant, while participating in a DVBTEF Program may be made. I hereby permit,
consent and authorize such materials of son/daughter as an individual or part of a group with or without text,
to be used for DVBTEF Activities.
_______________________________________________________
Parent/Guardian Signature
Date
_____________________________________________________________________________________________
Office Use:
Date Pymnt Rcvd:______________
Amount Received: ___________
Method of Pymnt:_________________
Entered in database?: __________ Comments:______________________________________________________