LGTA COMPETITIVE ACADEMY REGISTRATION
Player's Name
Birthdate
Parent's Name(s)
Phone Number
Address
Phone Number 2
Email Address
School Attending
Tournament Experience
None
1-5 Tournaments
6-10 Tournaments
USTA Ranking
ACADEMY PRACTICE SCHEDULE
Wednesdays - Fridays | 5:00 - 7:00 p.m. | Los Gatos High School
Saturdays, 12:00 - 4:00 p.m. | Los Gatos High School
Academy Day Pass
(4 Hour Academy Practice)
$60
Academy 10-Pack
(40 Hours of Academy Practice
$500
DISCOUNTS
Los Gatos High School Students: 15% Discount
Sibling Discount*: 50% Discount
*Discount applicable only if players participate in the same LGTA program.
* Only one discount may be applied
TOTAL DUE:
*Please make checks payable to Todd Dissly Athletics, LLC and mail to 207 Beethoven Lane, Los Gatos, Ca 95032
Indemnity Agreement
The undersigned in consideration of participation in this program agrees to indemnify and hold harmless Los Gatos Tennis Academy and Todd Dissly from any and all liability for any injury which may be suffered by the above named individual registered in this program, arising out of, or in any way connected with, participation in this program. By signing below, I represent that the participant is in good condition and has no impairment or ailment that would prevent or make it medically unwise for this person to participate in this program. I have read the above application and agreement, and fully understand that I assume all risks for any injuries received.
I have read and agree with the terms of this agreement.