Adult Programs
Winter Session 2012
Members receive a 10% discount.
Beginner adult classes include a Wilson® graphite racquet.
ADULT REGISTRATION FORM WINTER SESSIONS 2012
Name: __________________________________Home #: __________________
Work #:___________________________Cell#:________________________________
Email:_______________________________________________________
Home Address: ___________________________ City ____________________
Postal Code ___________Health card:__________________________
Any Health Conditions/Allergies:________________________________
Please check the program(s) you would like to register for:
Media Consent:
I give consent and permission for Lakewood Indoor Tennis Centre to photograph and/or record my tennis activities for educational and promotional purposes.
Signature ______________________________Date_____________________________
Cancellation: Cancellations must be requested in writing, one week prior to the first day of the program for a refund and will be subject to a $25.00 administration fee. No other refunds will be given unless accompanied by a medical certificate. LITC reserves the right to cancel any session; in this instance a full refund will be given.
Release, Warrant and Indemnity: In consideration of the acceptance of the application for enrolment of the participant named above, I for myself and (if applicable) on behalf of the participant I release, waive and discharge LITC and its agents, servants, contractors, representatives, successors and assigns of all claims, demands, and damages, costs, expenses, actions and cases of actions whether in law or equity, in respect of death, injury, loss or damage to my person or property or to the Participant howsoever caused.
I further undertake to hold and save harmless and agree to indemnify the Releases from and against any and all liability incurred by any or all of them arising as a result of or in any way connected to the participation of the participant in the LITC program. I warrant the Participant is physically fit to participate in the LITC program.
I acknowledge having read, understood and agree to the above Release, Warranty and Indemnity
Signature: _______________________Date: ___________________________
Office use only:
Program payment Total amount including GST:_________________________________________________
Method of Payment ( ) VISA ( ) MC ( ) CASH ( ) DEBIT ( ) CHEQUE
Received by: ____________________________________ Date:____________________________________
