Summer Program at Haynes Park

Transcription

1 A Division of Nehemiah Gateway Community Development Corporation Summer Program at Haynes Park 7-Week Outddor Tennis Program for youth 8 years and older Beginners through Advanced Players welcome! starts Monday June 11th through Thursday July 26th Days: Monday through Thursday Times: 8:30 am to 3:30 pm Location - Haynes Park Our closing Lunch Award Ceremony will be held on Thursday July 26th at Haynes Park at 11:30 am Participants can be picked up at 3:15 pm, unless enrolled in our Academic Enrichment & Dinner Program. Evening Program includes Tutoring, Computer Activities, Read-A-Thon, Dinner and SAT Prep from 4:00 pm to 7:30 pm; Monday through Thursday. Transportation provided if needed. Academic Enrollment & Dinner Program Tennis Rocks House 203 W. 23rd Street Wilmington, DE Payment Plan Available - Please call for an appointment Cash or Check payable to either Tennis Rocks Tutoring & Music Association or Nehemiah Gateway Community Development Corporation Registration May 15th, 2018 Seven - Week Tennis Program - $ Seven - Week Academic Enrichment Program - $ W. 23rd Street Wilmington, DE (Phone) (302) (Fax) (302) HarryShur@yahoo.com

2 A Division of Nehemiah Gateway Community Development Corporation Summer 7-Week Tennis Program Academic Enrichment & Dinner Program SAT Prep Program Music Program On-Line Credit Recovery Program Applicant Information First Last Age: Grade: Interested in learning more about: Tennis Tutoring (Note: Participant must be enrolled in an Tennis Rocks Tennis component to attend tutoring) Uniform Please check off sizes needed (Note: All sizes are Adult Sizes) X-Small Small Skorts/Shorts: Small Medium Large X-Large Shirts: Medium Large rd Street Wilmington, DE W. 23X-Large (Phone) (302) (Fax) (302)

3 READ-A-THON The Read-A-Thon will be part of our Academic and Enrichment Program beginning June 11th, Monday through Thursday from 4:00 to 7:30 pm. your child s participation in the activities entitles them to tutoring, On-Line Credit Recovery and Dinner. If you are interested in the Read-A-Thon Program, please fill out the information below and return to Harry Shur, Family Focus Tutoring and Director. My child(ren) is/are interested in participating in the Tennis Rocks Read-A-Thon Child s DOB: / / School: Grade: Age: Child s DOB: / / School: Grade: Age: City: State: Zip: My Child(ren) will participate in the Academic Enrichment & Dinner Program on the following days (Note: Activities will begin at 4:00 pm to 7:30 pm) Monday Tuesday Wednesday Thursday My Child(ren) require transportation from Haynes Park to the Tennis Rocks house at 203 W. 23rd Street, Wilmington Parent/Guardian Signature:

4 Participant Information: Registration Form DOB: Parent/Guardian Information: Relationship: School Information: School Attending: Grade: Medical/Physical Information: Physician Allergies/Condition: Medications: Emergency Contact: Relationship: Interest In: Tennis Tutoring Musicial Instrument SAT Prep GED Prep Shirt Size: S M L XL Shorts/Skirt: XS S M L XL (Circle One)

5 Agreement Form Student Street City: State: Zip: Date of Birth: Age: Gender: M F Home Cell School: Grade: Place of Employment: Work Cell Parent/Guardian Parent/Guardian: Check and Initial each statement below to confirm agreement. I confirm that the information this form is true and complete to the best of my knowledge. I give my permission for my child, name above, to participate in all Tennis Rocks programs/ activities. This includes Tennis Rocks staff transporting child to/from activities. I grant Tennis Rocks the right to take photographs of my child and I authorize Tennis Rocks, it s assigns, and transferee to copyright, use, and publish the same in print and/ or electronically. In the event I cannot be reached in an emergency, I hereby give my permission to the physician selected by Tennis Rocks program director to hospitalize or secure proper treatment, to order injection, anesthesia, or to order surgery for my child (name above). I hereby release Tennis Rocks Staff and Volunteers from any responsibility as a result of any injury to the child (named above) due to participation in Tennis Rocks activities. Parent/Guardian Signature: