REGISTRATION FORM
Please print this page and fill-out the form completely and mail along with the registration fee.

Mail Registration Information and Payment to:
Vanderbilt University Athletic Department
Dept. AT 40459
Atlanta, GA
31192-0459

Application:
Name of Camper ________________________________ Age:_______ Birth Date: ____/____/______
Name of Parent/Guardian ______________________________
Address ______________________________________City, State_______________ Zip__________
Home Phone (____)_____________Work Phone (____)_____________ Other (____)_____________
Sex: M / F
Experience Level: _______________ T-Shirt Size, adult shirts: S / M / L
Emergency Contact: ________________________________ Contact's Number (____)_____________
(If you have more than one child attending, please copy this form.)

Camp Fee: $275
Please make check payable to: Vanderbilt Tennis Camp

Camp Attending:
I June 30th- July 4th
II July 7th- 11th
III July 14th- 18th
IV July 21st- 25th

Discount Program:
A 10% discount will be offered for the following:
1) Early registration.(By May 1st with payment in full)
2) Two or more from the same family.
3) Vanderbilt University employees.
4) Multiple week campers.
5) Group discounts for teams (please call).
(Only one discount per family will be permitted.)

Cancellation Policy:
A refund (less a $50 processing fee) will be provided to anyone who cancels more than 30 days prior to the start of the camp. If cancellation occurs within 30 days of start of camp, a camp voucher will be issued. This can be transferable but is valid only though December 2005

Release of Liability and Authorization for Medical Treatment

List any physical condition that camp officials or physicians should be aware of ___________________________________________________________
The undersigned (parent/guardian if under 18 years of age) understands that the applicant will be engaging in physical activity during the program which contains an inherent risk of physical injury and undersigned assumes the risk and holds harmless Vanderbilt University, its officers, trustees, agents, and employees, including specifically all persons employed or hired by Vanderbilt to conduct the Vanderbilt Tennis Camp, from any and all liability for personal injury or property damage arising out of the applicant participation in the tennis camp program. I hereby grant permission for my child to attend the Vanderbilt Tennis Camp and to be treated by a licensed physician or a member of the Vanderbilt athletic training staff in the event of an injury, illness, or other mishap.
Applicant Name: ______________________________
Parent/Guardian Signature: _____________________________
Date: __________________ Insurance Carrier:____________________________________