Serve and Connect Registration

Child's Name *

First

Last

Gender *

Female
Male
Other/Non-Binary

How well does the participant speak English *

Fluent/Very well
Well
Not well
Not well at all

Ethnic origin: (check all that apply) *

Parent/ Guardian 1 *

First

Last

Gender *

Female
Male
Other/Non-Binary

Email *

Phone *

Address *

Zip code *

Parent/ Guardian 2

First

Last

Gender

Female
Male
Other/Non-Binary

Email

Phone

Address (if different from Participant)

Zip code

Emergency Contact Same as Parent/Guardian *

Yes
No

Emergency Contact Name *

Phone *

Relationship to participant *

Household Information (Optional)

Household Primary Language

Head of Household Type

Single Parent - Female
Single Parent - Male
Two Parent Household

Housing Type

Total gross annual income in the last 12 months:

Sources of Household Income (select all that apply):

Mother's Highest Level of Education

Parent/Guardian Signature *

IN CONSIDERATION OF THE ENROLLMENT OF THE PARTICIPANT IN THE SERVE AND CONNECT PROGRAM (THE "PROGRAM") COORDINATED BY NEW YORK JUNIOR TENNIS LEAGUE, INC. (NYJTL"), THE UNDERSIGNED, INTENDING TO BE LEGALLY BOUND, HEREBY, ON BEHALF OF THE UNDERSIGNED, THE PARTICIPANT, AND EACH OF THEIR RESPECTIVE HEIRS, EXECUTORS, REPRESENTATIVES, AGENTS, INSURERS, ADMINISTRATORS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY THE "RELEASORS"), WAIVES AND RELEASES ALL RIGHTS AND CLAIMS FOR DAMAGES THAT THE RELEASORS HAVE AGAINST NYJTL AND ITS AFFILIATES, SUCCESSORS, AND ASSIGNS, AND ALL OF THEIR RESPECTIVE OFFICERS, DIRECTORS, EMPLOYEES, TRUSTEES, AGENTS AN OTHER RELATED PERSONS OR ENTITIES, IN THEIR CORPORATE AND INDIVIDUAL CAPACITIES (THE "RELEASEES:) AND RELEASES THE RELEASEES OF ANY RELEASOR MAY SUFFER AS A RESULT OF THE PARTICIPANTS PARTICIPATION IN THE PROGRAM. THE UNDERSIGNED ACKNOWLEDGES AND AGREES ON BEHALF OF THE RELEASORS THAT THE UNDERSIGNED AND THE PARTICIPANT SHALL BE RESPONSIBLE FOR ALL RISKS OF PARTICIPATING IN THE PROGRAM. BY SIGNING THIS AGREEMENT, THE UNDERSIGNED GIVES PERMISSION FOR PHOTOGRAPHS AND ACCOMPLISHMENTS OF THE PARTICIPANT TO BE UTILIZED IN THE NYJTL PUBLICATIONS AND OTHER DOCUMENTS AS WELL AS IN FUNDRAISING AND MARKETING MATERIALS AND ON SOCIAL MEDIA PLATFORMS AND SERVICES OFFERED THROUGH NYJTL.

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