□ Session_____

□ All Day Camp

□ Evening Camp                                                   

□ Tournament Camp

□ Algebra Camp

                             LTS

2010-2011

                               REGISTRATION FORM

Please Print Legibly

Last Name: ____________________ First:___________________  Female□ Male□

Address: ______________________________ City: _______________Zip: _______

School: ____________________ Grade: ___ Age: ___ D.O.B.__________________

Birth Date: ________________ Home Phone: _______________________________

Parent Name:____________________ Cell: _____________ Work: ______________

Emergency Contact: ____________________________ Phone: _________________

E-Mail: ________________________________________________________________

waiver and release of all claims and assumption of risk

Please read this form carefully and be aware that in signing up and participating in the program/activity, you will be expressly assuming the risk and liability and waiving and releasing all claims for injuries, damages or loss which you or your minor child/ward might sustain as a result of participating in any and all activities connected with and associated with this program/activity.  I recognize and acknowledge that there are certain risks of physical injury to participants in this program/activity, and I voluntarily agree to assume the full risk of any and all injuries, damages or loss, regardless of severity, that my child or I may sustain as a result of said participation.  I do hereby fully release and forever discharge Love To Serve, Inc., its Board of Directors, Executive Director, employees or agents, the Chicago Park District & Chicago Public Schools, including its officials, agents, volunteers and employees.  In consideration of the acceptance of my registration, I do hereby, for and on behalf of myself, my heirs, and legal representatives, forever release and discharge said associations and coaches from any and all claims and demands of every kind which I may suffer or sustain, directly or indirectly in connection with said events, and all claims are hereby waived and released and I promise not to sue.

___________________________________________

Signature of parent or guardian

LOVE TO SERVE TENNIS AND EDUCATION FOUNDATION

________________________________________________________________________

OFFICE:

   773-233-6163

WWW.LOVETOSERVE.NET