Summer Jr PB Registration

2023 Summer Junior Pickleball Registration Form
(Mon - Thurs, 3 - 4pm)
Ages 10 & Up with Coach Alan

Limited to a max of 12 students each week.

Student's Name*

First Last

Age*

Please enter a number from 10 to 15.

Parent Information

Parent's Name*

First Last

Address*

Street Address City State ZIP Code

Parent's Email Address*

Enter Email Confirm Email

Home Phone*

Parents's Mobile Phone

Parent's Office Phone

I am a Great Falls Swim & Tennis Member*

Yes
No

Individual Weeks

Week 1: June 12 - 15 [Mbr]

Jr PB Pgm (Wk1) $120 [MEMBER]
Nothing/Clear

Week 1n: June 12 - 15 [NMbr]

Jr PB Pgm (Wk1) $140 [NON-MEMBER]
Nothing/Clear

Week 2: June 19 - 22 [Mbr]

Jr PB Pgm (Wk2) $120 [MEMBER]
Nothing/Clear

Week 2n: June 19 - 22 [NMbr]

Jr PB Pgm (Wk2) $140 [NON-MEMBER]
Nothing/Clear

Week 3: June 26 - 29 [Mbr]

Jr PB Pgm (Wk3) $120 [MEMBER]
Nothing/Clear

Week 3n: June 26 - 29 [NMbr]

Jr PB Pgm (Wk3) $140 [NON-MEMBER]
Nothing/Clear

Week 4: July 5 - 6 [Mbr] (2 days)

Jr PB Pgm (Wk4) $60 [MEMBER]
Nothing/Clear

Week 4n: July 5 - 6 [NMbr] (2 days)

Jr PB Pgm (Wk4) $70 [NON-MEMBER]
Nothing/Clear

Week 5: July 10 - 13 [Mbr]

Jr PB Pgm (Wk5) $120 [MEMBER]
Nothing/Clear

Week 5n: July 10 - 13 [NMbr]

Jr PB Pgm (Wk5) $140 [NON-MEMBER]
Nothing/Clear

Week 6: July 17 - 20 [Mbr]

Jr PB Pgm (Wk6) $120 [MEMBER]
Nothing/Clear

Week 6n: July 17 - 20 [NMbr]

Jr PB Pgm (Wk6) $140 [NON-MEMBER]
Nothing/Clear

Week 7: July 24 - 27 [Mbr]

Jr PB Pgm (Wk7) $120 [MEMBER]
Nothing/Clear

Week 7n: July 24 - 27 [NMbr]

Jr PB Pgm (Wk7) $140 [NON-MEMBER]
Nothing/Clear

Week 8: July 31 - Aug 3 [Mbr]

Jr PB Pgm (Wk8) $120 [MEMBER]
Nothing/Clear

Week 8n: July 31 - Aug 3 [NMbr]

Jr PB Pgm (Wk8) $140 [NON-MEMBER]
Nothing/Clear

Total Fees

$0.00

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Season

Summer: June 12th - August 3rd 2023

Medical Authorization & Release

Student Name*

First Last

Student Condition*

By checking this box it is understood that the student is in overall good physical health. If your child has a physical condition that may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such activities must be presented prior to the first program session.

Date of Medical Authorization*

By dating above, in an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the Pass Academy to take my/our child to the emergency room of the nearest hospital. I/we authorize that hospital and its medical staff to provide treatment deemed necessary for the well-being of my/our child.

Date of Parent Release*

By dating above, I agree to hold the Pass Academy and Great Falls Swim & Tennis Club harmless for injury or loss that may occur as a result of my participation in Pass Academy activities.

Cancellation Policy*

By checking this box I accept the following policy. All refunds are subject to fee charges of 6%.

Permission for Photo Use*

Yes
No

I give permission for photos of my child participating in Pass Academy programs to be taken and used for the Pass Academy Website and/or Facebook page. We understand that if students are identified, only their first names will be used.

Additional Information (optional)

Summer Junior Pickleball Registration

2023 Summer Junior Pickleball Registration Form(Mon - Thurs, 3 - 4pm)Ages 10 & Up with Coach Alan

Parent Information

Individual Weeks

Medical Authorization & Release

2023 Summer Junior Pickleball Registration Form
(Mon - Thurs, 3 - 4pm)
Ages 10 & Up with Coach Alan