Whitehouse Tennis lessons Child’s Name:_______________________________________________ Gender: Boy Girl Mother’s Name: ________________________________________ Cell #: ___________________ Father’s Name: _________________________________________ Cell #: ___________________ Emergency Contact: _____________________________________ #: ___________________ Known Allergies: ______________________________________________________________________________ Behavioral/Emotional/Physical Issues that might be helpful for us to know: ________________________________ _____________________________________________________________________________________________ You are welcome to stay and watch the lessons. Our intent is to handle minor scrapes, bruises, sprains with our local first aid kit. In an emergency, your child may be transported to the nearest hospital emergency room by 911 paramedics /EMS. Does your child have special medications that should be administered If yes, please explain: ______________________________________________________________________ Parent Signature: ____________________________________________________ Date: ___________________________ |