Session (circle one): Winter Spring Summer Fall
JR’S FIRST NAME: ___________________ LAST NAME:___________________________
ADDRESS:________________________________________________________________
__________________________________________________________________________
EMAIL:_____________________________ TELEPHONE:____________________
PARENT / GUARDIAN NAME: _________________________________________________
TELEPHONE #: ____________________________________________________________
ATFC MEMBER?: (PLEASE CIRCLE ONE) YES NO
ATFC Member #
AMOUNT PAID/CHARGED:______________ CHECK #/RECEIPT #:_____________
__________________________________________________________________________
PLEASE INDICATE YOUR DESIRED CLASS LEVEL: (PLEASE CIRCLE ONE)
ALL CLASS LEVELS ARE SUBJECT TO PRO APPROVAL
KOALAS PANDAS POLAR BEARS GRIZZLIES
***PLEASE NOTE: BASED UPON REGISTRATION AND SIGN-UP LEVELS, ATFC RESERVES THE RIGHT TO
CHANGE THE DAYS/TIMES OF A PARTICULAR CLASS. IF A CHANGE OCCURS, YOU WILL BE NOTIFIED
IMMEDIATELY. ALSO, ADDITIONAL CLASSES MAY FORM IF A PARTICULAR CLASS IS FULL.
PAYMENT IS DUE IN FULL UPON REGISTRATION. NO REFUNDS WILL BE GIVEN FOR ABSENCES.
PLEASE CONTACT LEO YOUNG OR ARI ZASLOW WITH ANY QUESTIONS (541) 482-4073.
__________________________________________________________________________
WAIVER (MUST BE SIGNED BY PARENT/GUARDIAN)
We the undersigned hereby agree that in consideration for the use of the Ashland Tennis and Fitness Club we do
now and forever hold the owners and employees harmless and without fault for any accident or injury of any kind
that we might receive while using these facilities. This agreement is binding on myself, my representatives and any of
my heirs or assigns.
NAME (PLEASE PRINT) SIGNATURE DATE
ASHLAND TENNIS & FITNESS CLUB
JUNIOR PROGRAM REGISTRATION SHEET
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