Player Information *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate *

MM

DD

YYYY

Preferred Start Date

MM

DD

YYYY

Preferred Lessons *

Select one or more options

Group

Private

If player is a minor, parent or guardian name

First Name

Last Name

Parent/Guardian Phone (if different than above)

(###)

###

####

Emergency Contact (other than parent/guardian) *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Release of Liability & Assumption of Risk Agreement *

insert language

Acknowledge