Junior Tennis Camp Registration Form

Please complete the camp registration form below.
*Required fields

Parent/Guardian Information

Last Name* First Name*
Street Address* City Postal Code* (e.g. N3T 4G4)
Phone* (e.g. 519-751-2345)    
   
Emergency Contact* Relation Emergency Phone Number*
Email (by providing your email address, you consent to receive electronic email messages from the club. You can unsubscribe at any time)


Camp Participant Information

Child
M
F
Last Name First Name*
Age*
Health Card Number*
1
2
3
4
5
6

 

Friday Subway Lunch Order

Child 1 Child 2 Child 3 Child 4 Child 5 Child 6
Choose Bread Choose Bread Choose Bread Choose Bread Choose Bread Choose Bread













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Select Toppings Select Toppings Select Toppings Select Toppings Select Toppings Select Toppings

Select Sauce Select Sauce Select Sauce Select Sauce Select Sauce Select Sauce



















 

Disclaimer

* I grant permission to the Dufferin Club of Brantford (DCOB) the right to use photos or videos of myself or family members, without compensation or approval rights, in brochures, websites and advertising material promoting the Dufferin Club.

   


I agree that in no event shall the DCOB is not responsible for lost or stolen items.  In no event, will the DCOB, its Directors, Staff and Volunteers be held liable to any party for any direct, indirect, incidental or other damages arising out of the use of the club site or personal injury or injury of a child or any other pecuniary loss, without limitation
Please check the box to continue.

Payment

If payment is being made by someone other than the Parent/Guardian entered above, please provide that person's name below before proceeding to Paypal:

Last Name First Name