Napeague Tennis Summer and Sports Day Camp | Application: Summer 2012

All fields denoted with an * are required for submission.

Name of the person filling out this form
Your Name*
Your Email*

Camper Information
First Name*   Last Name*
Sex Male* Female*
Date of Birth*     Day*   Month*   Year*
Grade* School*

Contact Information

Permanent Home Address*
Zip Code *Home Phone*
Parent 1 Name* Parent 2 Name*
Parent 1 Cell* Parent 2 Cell*
Parent 1 Email* Parent 2 Email*
Summer Address*
Summer Phone*
Summer Emergency Contact*
Summer Emergency Phone*

T-Shirt Size*
Junior: S    M    L      
Adult: S    M    L

Current Level of Tennis*
 Novice    Some Experience    Recreational    Competitive    Tournaments

2012 Program Dates*
Please choose desired week(s) at The Napeague Tennis and Sports Summer Day Camp
Entire Summer
Week 1: June 11-15
Week 2: June 18-22
Week 3: June 25-29
Week 4: July 2-6 (closed 7/4)
Week 5: July 9-13
Week 6: July 16-20
Week 7: July 23-27
Week 8: July 30 - August 3
Week 9: August 6-10
Week 10: August 13-17
Week 11: August 20-24
Week12: August 27-31

Program Type*

Full Day Program (10am-4pm)
Early Drop-Off (9am-10am)
Half Day Program (1pm-4pm)
**See our fees page for costs.
*** Lunch included daily with price of full camp or bring your own***

Transportation ($150/wk)*
Yes No

If you select "Yes" above, please specify the Pickup and Return Address
Pickup Address
Return Address

How did you hear about us?*

Refer a Friend
Please tell us if you'd like to refer a friend and receive a $50 credit per new player referral to Gotham Tennis Academy. To qualify, please provide the name(s) of the player, parent's name, email address and telephone number.

I give permission to my child to participate in all in and out of camp sponsored activities including but not limited to tennis, basketball, soccer, biking, hiking, boating, kayaking, swimming, and travel in vehicles. I understand and acknowledge that there are risks and dangers of injury inherent in these programs involving physical activity.As the Parent/Guardian of * , I hereby waive and release any and all full rights and claims for damages I may have against Doug Degroot, The Hamptons Tennis Company, Amagansett Beach and Bicycle, The Napeague Tennis Club, Gotham Tennis, Inc., Gotham City Tennis, LLC, its directors, agents, staff, and tennis professionals for any and all injuries sustained by the player. This includes transportation to and from the program in connection with any participation in this program. Gotham City Tennis, LLC is relieved of any liability as a result of negligence. I so hereby give my consent to medical emergency or otherwise, inclusive of necessary transportation in order to receive treatment in the event of injury or any other illness with my child.

In addition, I understand and agree that Gotham City Tennis, LLC retains the right to expel my child from its programs if he/she engages in conduct that is dangerous or disruptive to its programs. I further agree to let Gotham City Tennis, LLC use any images or pictures of my child in the program for advertising or marketing purposes.