Student Information

First Name *

Last Name*

Gender* ---MaleFemale

Date of Birth* JanFebMarAprMayJunJulAugSepOctNovDec-12345678910111213141516171819202122232425262728293031-1999200020012002200320042005200620072008200920102011201220132014201520162017

School*

Ethnicity* ---CaucasianAfrican AmericanHispanicAsianOther

Parent/Guardian Information

Parent First Name*

Parent Last Name*

Address*

Address Line 2

City*

State* ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareWashington DCFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

Zipcode*

Contact Number*

Parent E-mail*

Number of Children in Household 123456+

Household Income* $0 - $25K$25K - $50K$50K - $75K$75K - $100KOver $100K

Emergency Information

Emergency Contact Name*

Emergency Phone*

Other Information

How did you hear about ZGA? ---InternetFacebookRadioFriendE-MailOther

If "Other" please specify.

Please list any other family members currently enrolled in ZGA

Medical Release

Athlete’s Health Information:

Health Conditions (e.g. Asthma, Diabetes):

Allergies (e.g. to Medications, Food):

Prescription Medications:

Athlete’s Medical Care and Insurance Information

Physician/Pediatrician:

Phone Number:

Preferred Medical Facility:

Parental Consent

This agreement releases the Zina Garrison Academy from all liability relating to injuries that may occur while the athlete is participating in the Zina Garrison Academy program. By signing this agreement, I agree to hold the Zina Garrison Academy entirely free form any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence. I also acknowledge the risks involved with physical activity such as tennis. These include, but are not limited to, bodily injury and harm to the participant. I swear that I am participating voluntarily, and that all risks have been made clear to me. Additionally, I do not have any conditions that will increase my likelihood of experiencing injuries while engaging in this activity. By signing below, I forfeit all right to bring a suit against the Zina Garrison Academy for any reason. In return, I will receive tennis and education instruction. I will also make every effort to obey safety precautions as listed in writing and as explained to me verbally. I will ask for clarification when needed.

I Accept

Our Commitment to Excellence

The Zina Garrison Academy is committed to upholding the values on which the program was founded. In order to make these expectations clear, each player and parent is expected to review and sign an agreement to the expectations put forth by the ZGA staff. You may view the agreement HERE.

PLEASE SIGN BELOW to acknowledge that you have read and agree to the Zina Garrison Academy’s Commitment to Excellence.