Seminole High Performance After School Program Registration Packet 2017-­2018 > Registration Information Registration for High Performance Tennis begins Tuesday of May 2nd, 2017 in the Florida State Tennis Office at 139 Chieftain Way/Tully Gym Suite 2002, Tallahassee, FL 32306. Registration can be dropped off, mailed or return to one of our coaches. Each program will have a limited number of participants. Seminole High Performance is striving to have hard working, committed players. Waiting lists will be available. ALL forms and registration packet must be complete and turned in before your child can practice beginning August 7, 2017.
Instructional Options: Our pricing model will give more flexibility to families with players participating in other sports and school activities. Your allotment of days will be good during the period of August 7, 2017 through May 31, 2018. In your registration packet, you must choose which days your player will be attending. You may change your schedule on a monthly basis due to other activities. If a change is made, please let Lina Guzman know at [email protected]. Payment Options: Seminole High Performance is now a “year –round program” seeking committed junior tennis players. Checks and credit card payments will no longer be accepted. Please see options below. 1. Pay for year in advance (discounted) annual bank debit payment (fill out credit/debit authorization form) 2. Monthly Bank debit payment (Automatic Draft) between the 20th and the 25th of each month (fill out credit/debit authorization form) Payments are based on the number of days that are used during the season (Aug-­‐May) for example: If your child/athlete has 80 lessons package and is unable to attend the month of December, the monthly draft will occur to ensure full payments for the 80 lessons. Your child will have the opportunity to make up their lessons throughout the remainder of the season. Registration Policies: Lina Guzman must be notified with an e-­‐mail at least 60 days in advance if your child is discontinuing the program and to have your auto-­‐draft terminated. If notification is not received 60 days prior to beginning of month, your account will be drafted and charged. **Package days will no longer be shared among siblings** ****All days purchased must be used by May 31, 2018**** Please retain this page
> TRADITIONAL HIGH PERFORMANCE AFTER SCHOOL PROGRAM FSU Indoors only: Tuesday, Thursday 4:30-6:30pm Contact person Coach
Cristian
Killearn: Monday, Wednesday 4:30-6:30pm Contact person Coach Nathalie
-­‐1 day/per week = 40 days per year $1950/year, *monthly $195.00 over 10 months, 10% discount for yearly fee paid by August 24, 2017 $1755. -­‐2 days/per week = 80 days per year $3800/year, *monthly $380.00 over 10 months, 10% discount for yearly fee paid by August 24, 2017 $3420. -­‐Best Value: Unlimited Days per year $3950.00/year, *monthly installments available 10% discount for yearly fee paid by August 24, 2017 -­‐ $3555.00 NEXT LEVEL TRAINING HIGH PERFORMANCE PROGRAM (PLUS PROGRAM) at FSU Indoors only Students must be enrolled in the traditional Program to participate
Tuesdays and Thursdays Two hours 2:30-­‐4:30 1 day/per week= 40 days per year $2400/year, *monthly $240.00 over 10 months 2 days/per week = 80 days per year $3800/year, *monthly $380.00 over 10 months SHP Developmental Program Ages 8 -­‐13 at Killearn only Are you looking for a starter program for your child? Are you looking for a great after school activity to keep your child active? Not sure if tennis is your sport? Are you looking for a program that teaches the fundamentals in a small group setting? If you answered yes to any of these questions, then this program is for you!! This is a stepping stone program to prepare your child for the High Performance After School Programs. The program will put a major emphasis on fundamentals, fun, and sportsmanship. We will use this program for players looking to make that next step but not sure if they are ready to make the full commitment to a longer and more intensive workout. Players in this class will learn to keep score, play matches, hit the ball with correct technique and learn basic strategies. This program does not require a year-­‐long commitment as our Traditional Programs, but requires a 3-­‐month commitment. Monday and/or Wednesday 3:30-5:00
1 day/week $375.00 for 3 months, monthly $125.00 **BEST VALUE** 2 day/week 550.00 for 3 months *Note: Starting on August all our FSU tennis clinics are move to the indoor tennis facility. Players may use their purchased days how they choose to complete their allotted days. Players may also attend other locations to complete their allotted days! All Clinics will move to the FSU Indoor Facility (2566 Pottsdamer Rd) if it rains! Everyone is welcome to come on rainy days! Please retain this page
> Instructional Options (Please check program choice) DEVELOPMENTAL PROGRAM at Killearn location only -­‐SHP Developmental Program 3:30-­‐5:00 Mon and/or Wed _____ Monday Only $375.00 for 3 months -­‐$125/month _____ Wednesday Only $375.00 for 3 months -­‐$125/month _____ Monday and Wednesday $550.00 for 3 months BEST DEAL TRADITIONAL PROGRAM -­‐Traditional After School Program (FSU & Killearn) -­‐ 4:30-­‐6:30pm Mon, Tue, Wed, Thurs. Monday and Wednesday are at Killearn
____ 1 day/week= 40 days $1950/year -­‐$195/month M T W TH (please circle most likely day) _____2 days/week= 80 days $3800 -­‐ $380/month M T W TH (please circle most likely days) Tuesday and Thursday are at FSU indoor facility only
____ 1 day/week= 40 days $1950/year -­‐$195/month M T W TH (please circle most likely day) _____2 days/week= 80 days $3800 -­‐ $380/month M T W TH (please circle most likely days) NEXT LEVEL PROGRAM (PLUS) at FSU indoor Location only -­‐Next Level Plus Training Two Hours 2:30-­‐4:30pm Tues and Thurs ____ 1 day/week= 40 days $2400/year -­‐ $240/month T TH (please circle most likely days) ____2 days/week Tuesday-­‐ Thursday= 80 days $4800/year -­‐ $475/month ***Additional Lessons beyond selected days will have a cost of $60 per lesson*** Developmental program total: $_______________ Traditional Program Total: $_______________ Next Level Program Total: $_______________ Grand Total of Programs: $______________Monthly:____________Yearly:__________ Parent/Guardian Signature___________________________________Date:___________ Please return this page > Registration Information 1-­‐Athlete Information Last Name____________________________First Name__________________________________MI_______ Address ____________________________City/State_________________________________Zip__________ Athlete Email____________________________________Athlete Cell________________________________ Date of Birth_______________________________Age____________________________Sex_____________ Description of Any Health Problems ___________________________________________________________ ________________________________________________________________________________________ 2-­‐Athlete Information Last Name____________________________First Name__________________________________MI_______ Address ____________________________City/State_________________________________Zip__________ Athlete Email____________________________________Athlete Cell________________________________ Date of Birth_______________________________Age____________________________Sex_____________ Description of Any Health Problems ___________________________________________________________ ________________________________________________________________________________________ Parent Information (please print)
-­‐Mother’s Last Name________________________________First Name______________________________ Mother’s Email (please print)________________________________________________________________ WorK#__________________Cell______________________ -­‐Father’s Last Name_________________________________First Name______________________________ Father’s Email (please print)_________________________________________________________________ Work#__________________Cell_______________________
Would you like to receive e-­‐mails & text re bad weather report, announcements, monthly news etc. Please fill out the information below: Name___________________________________________ Email____________________________________Cell__________________ Name___________________________________________ Email____________________________________Cell__________________
Please return this page > CREDIT/DEBIT AUTORIZATION FORM I am (we are) registering ______________________ _______________________ for participation in the Seminole High Performance “year-­‐round” Tennis Program. I have received and understand the policies and payments options. I (we) hereby authorize Seminole High Performance and American Commerce Bank to initiate entries to my (our) checking/savings account(s) at________________________ (Financial Institution) to cover monthly participation fees and, if necessary, initiate adjustments for any transactions credit/debit in error. This authority will remain in effect until I (we) notify Lina Guzman by e-­‐mail to cancel it at least 60 days in advance to afford the Company and the Financial institution a reasonable opportunity to act on it. Bank Address (Branch, City, State and Zip Code) __________________________________ __________________________ Signature of account Holder Date Name of account Holder (please print) Address (please print) Select ONE of the following payments options: -­‐Set monthly bank debit amount (between 20th and the 25th of each month):_______________ -­‐Annual bank draft Amount: _______________________ *Checking/Savings Account Number:___________________________________________ *Routing Number: __________________________________________________________ (Look between these symbols l: :l on the bottom left of your check) Please attach a cancelled check here.
Do not use a deposit slip
Please return this page > Seminole High Performance Tennis After School Program
Medical Release/Liability Release/ Permission Slip Form Please Fill Out Completely
Child’s Name:_________________________Home Phone (_____)-_____- ______
Birthday (M/D/Y) ______________Sex (M) ______ (F) _____Age:_____________
Street Address:___________________________________________________________
City:____________________________State: ___________ Zip:______________
MEDICAL RELEASE
In the event my child (children) becomes ill or is injured while under The Tennis Program supervision, I authorize the
“Person In Charge” (defined as the person in charge of Seminole High Performance Tennis After School Program or the
Person In Charge’s designee) to take the following steps in the following order:
1. Contact the parent(s) of the child and follow his/her instructions.
2. In the event of an emergency when neither parent can be contacted, the Person in Charge will immediately attempt to
contact the child’s physician and follow his/her instructions.
3. If the child’s physician cannot be immediately reached, the Person In Charge will use their own discretion in contacting a
properly licensed practicing physician or the nearest hospital and follow his/her instructions.
4. At the same time as the preceding steps are occurring, I authorize the “Person In Charge” to call for/order emergency
medical services for the child. If in the opinion of a properly licensed and practicing physician my child needs medical or
surgical services which require my consent before being supplied, and I cannot be reached, I hereby authorize, appoint and
empower the “Person In Charge” to furnish, on my behalf, such written or oral authorization as may be so required. Further,
I release The Tennis Program and its representatives from any liabilities which might arise from the giving of such
authorization, it being my desire that my child be furnished with such medical or surgical services as soon as reasonably
possible after the need arises.
ALLERGIES OR SPECIAL MEDICAL INFORMATION Statement of Health (To be filled out by
parent or guardian)
-Emergency Contact: Name_________________________________________________________
Phone – Home (_____)_____-________________ Work (_____) ____-___________________
Cell (______)_______-___________________
-Alternate Emergency Contact: Name_________________________________________________
Phone – Home (____)_____-________________________Work(_____)_____-________________
Cell (____)_____-_______________________
-Parent or guardian:_________________________________Employer: ____________________
Family Insurance Company: ________________________________ Policy # _________________
Phone #____________________Name of Insured: ______________________________________
Phone # ______________________________
Primary Care Physician: __________________________________________
Phone #______________________________
Immunizations: Date of last Tetanus Shot/Boosters:
_________________________________________________________
List medication(s) participant is currently taking:
___________________________________________________________
List all medications that participant is bringing:
____________________________________________________________
ALLERGIES (check any that apply):
_ Drugs _ Plants _ Food _ Bee Stings _ Other
_________________________________________________________ _ Yes _ No: My child can
be given pain reducing medication (i.e., Tylenol, aspirin, etc.) as deemed necessary by Person In
Charge. If NO, please list medications not to be dispensed:
_________________________________________________
**All medications, including non-prescription drugs must be turned into the “Person in
Charge” upon arrival.
Please return this page > LIABILITY RELEASE
In consideration of the furtherance of your purposes, objectives and work, and in consideration of
your permitting my child to participate in The Tennis Program, I do for myself and my heirs,
executors, administrators and assigns, hereby waive and release any and all rights and claims for
damages which I may have against the Tennis Program as well as any other person connected
with the activity including said person’s heirs, executors, administrators, successors, and assigns
for any and all injuries which my child may suffer while taking part in said activity or as a result
thereof.
It is agreed that all risks associated with watching and/or participating in The Tennis Program
including but not limited to bodily injury, are assumed by the student and his/her parents and/or
guardian, and that this assumption is acknowledged, approved, and agreed to by said student and
his/her parents and/or legal guardian as indicated by their signature hereto.
I hereby certify that ___________________ is physically able to participate in The Tennis Program
and that I know of no physical impairments which would in any manner limit his/her participation in
such a program.
PARENTAL AUTHORIZATION
I hereby give permission for my child to participate in The Tennis Program, and I further certify that
the health history given to The Tennis Program is correct as far as I know and the “Person In
Charge” has permission to engage in all prescribed activities, except as noted. IN CASE OF
EMERGENCY, after following the procedures prescribed above, I hereby give permission to the
physician or hospital selected by the Person In Charge to hospitalize, secure proper treatment for,
and to order injections, anesthesia, or surgery for my child.
Date:___________________
X_________________________________________________________
> Please return this page >