Registration – Todd Tennis

Student Name

First

Last

Parent/Guardian Name

First

Last

Parent/Guardian Email

Parent/Guardian Phone

yes, Parent/Guardian Shirt

School Attending

Grade Entering Fall 2026

Student Shirt Size?

Tennis Class Schedule: Select your preferred Class Location & Time

Middletown HS (Mon & Wed 9-10:15AM)
Middletown HS (Mon & Wed 10:30-11:45AM)
Middletown HS (Mon & Wed 6-7:15PM)
Fenwick HS (Mon & Wed 9:30-10:45AM)
Miami University of Middletown (Tues & Thurs 9-10:15AM)
Miami University of Middletown (Tues & Thurs 10:30-11:45AM)
Miami University of Middletown (Tues & Thurs 6-7:15PM)

Does your child have any medical conditions or allergies?

If yes, please explain:

Person to contact other than Parent/Guardian:

First

Last

I, the parent/guardian, give my permission for emergency medical treatment due to illness or injury sustained by the child named above in the event I, or the person named below, cannot first be contacted.

Person to contact other than Parent/Guardian Phone:

Relationship to Child:

Permission & Agreement

I agree and give my permission

To the best of my knowledge, my child is physically fit, and able to participate, and I agree to furnish a doctor’s statement upon request of the R.C. Todd Memorial Foundation. I understand that as the parent/guardian, I bear financial responsibility for my child’s physical condition. I agree that pictures of my child may be used in ways that promote the Todd Tennis program. I hereby agree that the R. C. Todd Memorial Foundation, its officers and designates, shall not be liable for any injury or loss which my child may sustain while participating in activities of any kind whether sponsored by or under the supervision of the R. C. Todd Memorial Foundation.

Signature of Parent/Guardian:

Date:

I agree to the following charge

Registration Fee – $50.00

Credit Card