Malibu Summer Tennis Camp
Adult Application - 2008
(310) 774-0231    www.malibusummertenniscamp.com
·          Complete and sign the application form (please print clearly)
·          Mail in application with deposit (deposit $200/week). Balance is due May 15. If you sign up after May 15, full payment is required
·          Make all checks payable to: Malibu Summer Tennis Camp
·          Mail to: Malibu Summer Tennis Camp, PO Box 178, Riverton, UT 84065 or
·      Fax completed application to 310-774-0234
 








Last Name: ____________________________ First Name:______________    Male     Female

Address: __________________________________City:____________________ State:____ Zip:________

Home phone: _______________________________Cell Phone:__________________________________

Email Address:____________________________________________________ Date of Birth:___________

Medical Ins Company: ______________________________________________ Policy #:_______________

Any Medical Conditions? __________________________________________________________________

Any Allergies? __________________________________________________________________________

Any Medicine Taken?____________________________________________________________________

Emergency Contact:______________________________________________________________________

T-Shirt Size : Adult      S        M        L        XL        XXL

Adult Camps
 July 11 - July 13                                                      
 Aug 8 - Aug 10                                              

Adult Camp Rates
 Resident - $495.00
 Day Camp  - $395.00          

 

Payment
 $200 deposit                              Full Tuition of $____________                       
                   

Roommate Request:___________________________________USTA Rating (1.5 - Open)____________

Please include a copy of medical card or coverage
I hereby authorize the staff of the Malibu Summer Tennis Camp to act for me according to their best judgment in any emergency requiring medical attention and I hereby waive and release the camp from any and all liability for any injuries incurred while at camp. I have no knowledge of any physical impairment that would be affected by my participation in the camp program as outlined in the brochure or website. I will be responsible for any medical charges in connections with my attendance at camp. I, also, understand the Malibu Summer Tennis Camp retains the right to use, for publicity and advertising purposes, photographs taken at camp. There is a $50 fee for all cancellations. I have read the above regulations of the camp and I agree to abide by them.



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Signature                                                                             Date

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Print Name