Jacksonville BeachTennisCenter

Summer Camp Application

~ 2018~

NAME: AGE: M/ F/
ADDRESS:
CITY: ZIP:
Parent name:______Cell#______Home #______Email:
In case of emergency, please notify: ______
Relationship: ______Phone: ______Cell #______
Doctor’s Name: ______Phone # ______
Any pertinent medical problems we should be made aware of? _____ Yes _____ No If yes—please explain:
______
Is applicant on any prescribed medication(s): _____Yes _____No If yes—specify: ______

CAMP: ______

DATE OF CAMP: ______

Please make checks payable to:

City of Jacksonville Beach

HuguenotTennisCenter

218 S. 16th Ave., Jacksonville Beach, Florida 32250 Phone: 904-247-6221

City of Jacksonville Beach

DEPARTMENT OF RECREATION, PARKS & OCEAN RESCUE

2508 South Beach Parkway. Jacksonville Beach, Florida 32250

Phone: (904) 247-6236

DISCLAIMER

NOTICE FOR ADULTS and MINOR CHILDREN’S NATURAL GUARDIANS

READ THIS FORM COMPLETELY AND CAREFULLY.

You are agreeing to let yourself and or your minor child engage in a potentially dangerous activity. You are agreeing that even if the City of Jacksonville Beach Parks and Recreation Department and the City of Jacksonville Beach uses reasonable care in providing this activity, there is a chance you and or your child may be seriously injured or killed by participating in this activity because there are certain dangers inherent in the activity which cannot be avoided or eliminated.

By signing this form you are giving up your child’s, and or your right and your right to recover from the Jacksonville Beach Parks and Recreation Department, the City of Jacksonville Beach and its employees in a lawsuit for any personal injury, including death, to you and or your child or any property damage that results from the risks that are a natural part of the activity. You have the right to refuse to sign this form and the city of Jacksonville Beach Parks and Recreation Department and the City of Jacksonville Beach has the right to refuse to let you and or your child participate if you do not sign this form.

I have read and understand the terms of this Release.

______

Adult Participant Name (please print)

______Date: ______

Signature of Adult Participant

______

Name Parent or Guardian of the minor

______Date: ______

Signed

Child(s) Name: ______

(Please print)

______

______

Jacksonville Beach

Tennis Center
At HuguenotPark
~ 2018~
SUMMER CAMPS AND PROGRAMS

AGES: 5 – 15

JUNIOR CAMP I: 10AM-12PM
June12–14 (Makeup Day: June15) / $80.00Total
6 HOURS / $40.00
DEPOSIT
JUNIOR CAMP II: 10AM-12PM
June 19 – 21 (Makeup Day: June 22) / $80.00Total
6 HOURS / $40.00
DEPOSIT
JUNIOR CAMP III: 10AM-12PM
June26 – 28 (Makeup Day: June 29) / $80.00Total
6 HOURS / $40.00
DEPOSIT
JUNIOR CAMP IV: 10AM-12PM
July 10 – 12 (Makeup Day: July 13) / $80.00Total
6 HOURS / $40.00
DEPOSIT
JUNIOR CAMP V: 10AM-12PM
July 17 – 19 (Makeup Day: July 20) / $80.00Total
6 HOURS / $40.00
DEPOSIT
JUNIOR CAMP VI: 10AM-12PM
July 24 – 26 (Makeup Day: July 27) / $80.00Total
6 HOURS / $40.00
DEPOSIT

ADULT CLINICSALSO AVAILABLE

PLEASECHECK WITH PRO SHOP

HuguenotTennisCenter

218 S. 16th Ave., Jacksonville Beach, Florida32250

Phone: 904-247-6221