TENNIS CAMP SUMMER REGISTRATION FORM

Mail to E.B.R.C.

225 Highway 18 South

East Brunswick, NJ 08816

NAME:                                                        

ADDRESS:                                                 

CITY:                                                          

STATE:                              ZIP:                    

BIRTHDATE:         /        /       
                     day   month    year        

Circle One:                    Male        Female

LEVEL:  Circle One       Never Played                      Beginner
                                      Intermediate                     Advanced
                              Tournament (provide sectional and/or national ranking)

Parents’ names:                                         

Home Phone:                                             

Business Phone:                                        

Cell Phone:                                                          

Circle One: Full Day     Half Day (am/pm)

Session Date(s):                                         

EMERGENCY CONTACT:                           

EMERGENCY PHONE:                               

SIGNATURE: