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PicklePlayground Clinic Registration

Parent's email (will be used for correspondence)

Parent's name

Parent's phone

Child's name

Child's age (at time of clinic)

Emergency contact name and phone number

Friends at the clinic

Please give details of allergies, who is authorized to pick up child at end of day, and any other special considerations.

Clinic sign-up

	Ages 5-8	Ages 8-13
Bessborough Drive Elementary School (Saturdays, May 2-Jun 6) (6 sessions)
Rosedale Jr. Public School (Sundays, May 3-Jun 14), in partnership with Mooredale (7 sessions)
Hillcrest Community School (Saturdays, May 2-Jun 6) (6 sessions)

Total $

Photo/Video Release: This year PicklePlayground will be filming a promotional highlights video for use on the PicklePlayground website. I understand that my child may appear in this video. Please email Jeremy if this presents a concern. Jeremy sincerely appreciates your support, as it helps his business grow and allows him to share the joy of pickleball with others.

Photo/Video Release: This year PicklePlayground will be filming a promotional highlights video for use on the PicklePlayground website. I understand that my child may appear in this video. Please email Jeremy if this presents a concern. Jeremy sincerely appreciates your support, as it helps his business grow and allows him to share the joy of pickleball with others.

I agree

How did you hear about us?

Mooredale members, please choose 'Mooredale'