4 STAR TENNIS ACADEMY AT BULLIS
HIGH SCHOOL PLAYERS GROUP
SUMMER SESSION
JUNE 8, 2015 – AUGUST 28, 2015
Monday – Friday 3:00-6:00pm
This program consists primarily of players who are currently on their High School Varsity team (or those who would
like to try out for their H.S. team in the upcoming school year), along with current USTA/MID-ATLANTIC SECTION
tournament players. The emphasis is on consistency of strokes, match play, and strategy with structured drills to
enhance footwork and conditioning.
FEES:
$265 PER WEEK ($215 FOR WK. 4); $960 FOR 4 WEEKS; $1,960 FOR 8 OR MORE WEEKS
A DAILY DROP-IN RATE OF $60 IS ALSO AVAILABLE
REGISTRATION: Students are accepted on a first-come/first-serve basis. Full payment, by check, must accompany the
registration below. CANCELLATION/WITHDRAWALS: Must be received prior to the start of the program and are
subject to a $50 service charge. WE DO NOT GIVE REFUNDS!!!
2015 USTA/MAS RANKED & HIGH SCHOOL VARSITY PLAYERS REGISTRATION FORM
Student’s Name: ____________________________________ Parent’s Name: _______________________________
Birthdate: __________________Age:____ Gender: ____
Ranking, if applicable (USTA/MAS): ____________
Address: _________________________________________________________________________________________
Home Phone: ________________________ Cell: ________________________ Office: __________________________
Email Address: ____________________________________________
ENROLL MY CHILD IN: 8 Weeks or more - $1,960 (___) PLEASE CHECK ALL WEEKS BELOW,
OR, PLEASE MARK WEEKLY SESSIONS BELOW: $265 per week ($215 for week 4); $960 for 4 weeks; $1,960 for 8 or
more weeks:
1. June 8-12
(___)
5. July 6-10
(___)
9. August 3-7
(___)
2. June 15-19
(___)
6. July 13-17
(___)
10. August 10-14
(___)
3. June 22-26
(___)
7. July 20-24
(___)
11. August 17-21
(___)
4. Jun29-July 2*
(___)
8. July 27-31
(___)
12. August 24-28
(___)
** Camp will not be held Friday, July 3th
PLEASE MAKE CHECKS PAYABLE TO: 4 STAR TENNIS ACADEMY AT BULLIS. MAIL TO: 4 Star Tennis at
Bullis, 10601 Falls Road, Potomac, MD 20854. Office Phone #: 301-299-0007; Website: 4startennis.com; Email:
[email protected]
STUDENT’S NAME: ____________________________________________
It is understood that the student is in overall good physical health. In the event that there is a physical condition that
may limit or restrict participation in certain activities, a physician’s note granting permission to participate in such
activities must be presented prior to the first class session.
MEDICAL AUTHORIZATION:
In an emergency, when I/we cannot be contacted, I/we hereby authorize the staff of the 4 Star Tennis Academy to
take my/our child to the emergency room of the nearest hospital. I/we authorize the hospital and its medical staff to
provide treatment deemed necessary for the well-being of my/our child.
Parent/Guardian Signature
Date
Parent/Guardian Signature
Date
RELEASE:
By signing this document, I agree to hold the 4 Star Tennis Academy and Bullis School harmless for injury or loss that
may occur as a result of my participation in 4 Star activities.
Student Signature
Date
Parent/Guardian Signature
Date
__________________________________________________________________________________________________