Term Reg Form

Please Note. We require one separate registration form for each child. First child pays full fees, Additional siblings receive a 10% discount. Thank you.*

Yes, I understand

Please Enter Today's Date

Month*

Day*

Year*

Today Date

Fall and Winter Tennis Season

End Date Fall

Number Of Days Fall

Spring Tennis Season

End Date Spring

Number Of Days Spring

Section Break

Number Of Days

How did you hear about Rob Nickels Tennis at Parkland Tennis Center?*

Referred by a friend
I am on your email listing
Facebook
Advertising flyer received in the mail
Attended Summer Camp
Other

Please select all that apply

Name of the Player that referred you*

First Last

We would like to personally THANK them!

I discovered Rob Nickels Tennis by:*

OK. Let's move on and get some information about your child.*

Ok

Child's Information

Player's Name*

First Last

Male or Female*

Player Date of Birth (if under 18)*

Player's Age (if under 18)

OK. Let's move on and gather some information about the parents or guardians of the child.*

Ok

Parent / Guardian Information

Primary Parent/Guardian Name*

First Last

Parent/Guardian Primary Phone

Parent / Guardian Primary Email*

Enter Email Confirm Email

Parent / Guardian Secondary Email

Enter Email Confirm Email

Home Address*

Street Address City State ZIP Code

Additional Parent/Guardian Name*

First Last

Parent/Guardian Additional Phone*

In Case of Emergency Phone*

Emergency Contact Name*

First Last

OK. Let's move on and select your child's tennis classes*

Ok

Tennis Class Reservation

Have you already submitted this form for a brother or sister?

Yes
No

Name of brother or sister who is already enrolled.*

First Last

You will receive a 10% discount on the rates you will see below..*

OK, I understand

Are you a member of Parkland Tennis Center?*

Yes, I am a member of Parkland Tennis Center
No

Members of Parkland Tennis Center receive a $14.00 per month discount on group class fees and also added benefits such as unlimited play at the tennis courts, discounts on events, racket sales, t-shirts and so much more. Visit CityOfParklandTennis.com for more details

Please enter your Parkland Tennis Center membership number.*

Do you have a coupon code?*

Yes
No

Enter Coupon Code

Which class will the child be participating in?*

Future Stars (age 4-7)
Junior Academy Group (age 8+)
Academy Group (Advanced)
Elite Group (Invitation only)

How many classes would you like your child to attend each week?*

Future Stars Schedule

Please select the days (2) to reserve a space in the Future Stars Group Class for your child.*

Monday 4:30pm-5:30pm
Wednesday 4:30pm-5:30pm
Friday 4:30pm-5:30pm
Saturday 8:30am-9:30am

Please select the days (3) to reserve a space in the Future Stars Group Class for your child.*

Monday 4:30pm-5:30pm
Wednesday 4:30pm-5:30pm
Friday 4:30pm-5:30pm
Saturday 8:30am-9:30am

Please select the days (4) to reserve a space in the Future Stars Group Class for your child.*

Monday 4:30pm-5:30pm
Wednesday 4:30pm-5:30pm
Friday 4:30pm-5:30pm
Saturday 8:30am-9:30am

Junior Academy Goup Schedule

Select Days (2) your child will be attending the Junior Academy Group Class*

Monday 5:30pm-6:30pm
Tuesday 4:30pm-5:30pm
Wednesday 5:30pm-6:30pm
Thursday 4:30pm-5:30pm
Friday 5:30pm-6:30pm
Saturday 9:30am-10:30am

Select Days (3) your child will be attending the Junior Academy Group Class*

Monday 5:30pm-6:30pm
Tuesday 4:30pm-5:30pm
Wednesday 5:30pm-6:30pm
Thursday 4:30pm-5:30pm
Friday 5:30pm-6:30pm
Saturday 9:30am-10:30am

Select Days (4) your child will be attending the Junior Academy Group Class*

Monday 5:30pm-6:30pm
Tuesday 4:30pm-5:30pm
Wednesday 5:30pm-6:30pm
Thursday 4:30pm-5:30pm
Friday 5:30pm-6:30pm
Saturday 9:30am-10:30am

Select Days (5) your child will be attending the Junior Academy Group Class*

Monday 5:30pm-6:30pm
Tuesday 4:30pm-5:30pm
Wednesday 5:30pm-6:30pm
Thursday 4:30pm-5:30pm
Friday 5:30pm-6:30pm
Saturday 9:30am-10:30am

Academy Goup Schedule

Select Days (2) your child will be attending the Academy Group Class*

Monday 6:30pm-8pm
Tuesday 5:30pm-7pm
Wednesday 6:30pm-8pm
Thursday 5:30pm-7pm
Friday 6:30pm-8pm
Saturday 10:30am-12pm

Select Days (3) your child will be attending the Academy Group Class*

Monday 6:30pm-8pm
Tuesday 5:30pm-7pm
Wednesday 6:30pm-8pm
Thursday 5:30pm-7pm
Friday 6:30pm-8pm
Saturday 10:30am-12pm

Select Days (4) your child will be attending the Academy Group Class*

Monday 6:30pm-8pm
Tuesday 5:30pm-7pm
Wednesday 6:30pm-8pm
Thursday 5:30pm-7pm
Friday 6:30pm-8pm
Saturday 10:30am-12pm

Select Days (5) your child will be attending the Academy Group Class*

Monday 6:30pm-8pm
Tuesday 5:30pm-7pm
Wednesday 6:30pm-8pm
Thursday 5:30pm-7pm
Friday 6:30pm-8pm
Saturday 10:30am-12pm

Elite Goup Schedule

Select Days (2) your child will be attending the Elite Group Class*

Tuesday 5:30pm-8pm
Thursday 5:30pm-8pm
Friday 5:30pm-8pm

Select Days (3) your child will be attending the Elite Group Class*

Tuesday 5:30pm-8pm
Thursday 5:30pm-8pm
Friday 5:30pm-8pm

FANTASTIC OFFER

We can help you save 10% off your monthly fees?*

Kindly select the option that you prefer.

Yes, I would like to save 10% and make payment in full for the remainder of the Fall and Winter Session
No, I will pay by the month and receive no discounts on our monthly fees

Future Stars Fall and Winter Session: 2 classes per week*

Price: $805.50

Future Stars Fall and Winter Session: 3 classes per week*

Price: $1,075.50

Future Stars Fall and Winter Session: 4 classes per week*

Price: $1,255.50

Junior Academy Fall and Winter Session: 2 classes per week*

Price: $805.50

Junior Academy Fall and Winter Session: 3 classes per week*

Price: $1,075.50

Junior Academy Fall and Winter Session: 4 classes per week*

Price: $1,255.50

Junior Academy Fall and Winter Session: 5 classes per week*

Price: $1,345.50

Academy Fall and Winter Session: 2 classes per week*

Price: $1,210.50

Academy Fall and Winter Session: 3 classes per week*

Price: $1,615.50

Academy Fall and Winter Session: 4 classes per week*

Price: $1,885.50

Academy Fall and Winter Session: 5 classes per week*

Price: $2,020.50

Elite Fall and Winter Session: 2 classes per week*

Price: $2,155.50

Elite Fall and Winter Session: 3 classes per week*

Price: $2,875.50

Future Stars Pay by the Month: 2 classes per week*

Price: $179.00

Future Stars Pay by the Month: 3 classes per week*

Price: $239.00

Future Stars Pay by the Month: 4 classes per week*

Price: $279.00

Junior Academy Pay by the Month: 2 classes per week*

Price: $179.00

Junior Academy Pay by the Month: 3 classes per week*

Price: $239.00

Junior Academy Pay by the Month: 4 classes per week*

Price: $279.00

Junior Academy Pay by the Month: 5 classes per week*

Price: $299.00

Academy Pay by the Month: 2 classes per week*

Price: $269.00

Academy Pay by the Month: 3 classes per week*

Price: $359.00

Academy Pay by the Month: 4 classes per week*

Price: $419.00

Academy Pay by the Month: 5 classes per week*

Price: $449.00

Elite Pay by the Month: 2 classes per week*

Price: $479.00

Elite Pay by the Month: 3 classes per week*

Price: $639.00

Payment Details

One Time Payment Total (prior to sibling discount being applied if applicable)

Price: $0.00

One Time Payment Sibling Discount

Price: $0.00

One Time Payment Total To Be Charged Today*

Price: $0.00

Payment Details Monthly By Choice

Making Monthly Payments By Choice (prior to sibling discount being applied if applicable)

Price: $0.00

Making Monthly Payments By Choice Sibling Discount

Price: $0.00

Product Name

Price: $14.00

Making Monthly Payments Total to be Charged Today for Remainder of Current Month By Choice (Pro-Rated)

Price: $0.00

Payment Details Monthly Less that 131 Days

Making Monthly Payments Less Than 131 (prior to sibling discount being applied if applicable)

Price: $0.00

Making Monthly Payments Sibling Discount Less Than 131

Price: $0.00

Product Name

Price: $14.00

Making Monthly Payments Total to be Charged Today for Remainder of Current Month Less Than 131 (Pro-Rated)

Price: $0.00

Section Break

Total To Be Charged Today

This amount has been pro-rated for you.

Price: $0.00

Recurring Payment Amount (first payment on the 1st day of next month)

Price: $0.00

Let's Continue

You will now be asked to choose your own Username and Password so you can have a secure portal on our website to make any changes to your child's tennis classes.*

Ok, I understand.

Please choose a Username and Password

With this username and password you will be able to log-on to your own private "My Account" Page on our web-site.

Username*

Password*

Enter Password Confirm Password

Thank you for choosing your new username and password.. The last step is to complete the registration by submitting a secure payment.*

OK, I understand

IMPORTANT BILLING INFO - PLEASE READ CAREFULLY

Automatic Recurring Billing begins with this payment. We have very simple rules and policies regarding pausing or stopping the recurring payments.

RECURRING MONTHLY PAYMENTS*

By checking the box, I authorize Rob Nickels Tennis Inc to charge the credit or debit card indicated in this authorization form according to the terms selected in the Player Registration form and begin automatic recurring payments. This payment authorization is for monthly Automatic Recurring Payments. I certify that I am an authorized user of this credit or debit card and that I will not dispute the scheduled payments with my credit card company provided the transactions correspond to the terms indicated in this authorization form. There will be no refunds and no prorating of the monthly fees. I completely understand that my recurring payments will remain in effect until I notify the business by submitting the "Cancellation of Contractual Agreement Form" at least 15 days prior to the next automatic payment.

Cancellation of Recurring Payments*

To cancel or pause recurring payments Rob Nickels Tennis Inc. requires the "Cancellation of Contractual Agreement Form" to be submitted. This form is located in the After School Tennis Program Section of your “My Account” page at www.CityofParklandTennis.com. Absolutely no other form of cancellation notification will be accepted. Rob Nickels Tennis Inc. require 15 days advanced notice prior to your next monthly recurring payment to stop the next payment from processing. Cancellation forms submitted with less than 15 days prior to the next payment will result in one more payment being processed as normal. I understand that absolutely no refunds or credit will be granted if the 15 days’ prior notice has not been provided.

MAKE-UP CLASSES*

Make-up days will only be granted only if the class is cancelled by Rob Nickels Tennis, Inc and/or The City of Parkland agents. By checking the box, I understand that make-up classes will not be granted if your child is absent from a class that was not cancelled by Rob Nickels Tennis, Inc and/or The City of Parkland agents. Make-Up classes are to be attended on a different day when the same group level is offered. I understand that cancelled classes cannot be switched for private or semi-private classes. No pro-rating of future or past payments will be made in lieu of make-up classes.

LIABILITY:*

TERMS AND POLICIES. Waiver for minors. Read carefully before checking the box. As an adult or the parent and legal guardian of the above named minor, I give permission for myself or my child to participate in this tennis program. I hereby agree to indemnify and hold harmless, Rob Nickels, The City of Parkland, and its agents from and against any and all claims, demands or causes of actions of whatsoever kind, and for any resulting injuries, losses, costs, damages, liabilities, expenses and attorney's fees arising out of his/her participation in this activity. NO REFUNDS WILL BE GIVEN. PHOTO/VIDEO CONSENT – sometimes we may take photos/videos in the tennis sessions. These may be used on promotional materials such as brochures and posters or on our web site. At no other times will the photos or videos be made public. Photos may also be made available for you to download. PLEASE CHECK THE BOX.

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Child's First and Last Name

Same as Home Address

Billing Address*

Street Address City State ZIP Code

Same as Parent / Guardian Primary Email

Cardholder's Email*

Enter Email Confirm Email

Same as Primary Parent/Guardian Cell Phone

Card Holder's Phone*

Comments

This field is for validation purposes and should be left unchanged.

Please Enter Today's Date

Fall and Winter Tennis Season

Spring Tennis Season

Section Break

Child's Information

Parent / Guardian Information

Tennis Class Reservation

Future Stars Schedule

Junior Academy Goup Schedule

Academy Goup Schedule

Elite Goup Schedule

FANTASTIC OFFER

Payment Details

Payment Details Monthly By Choice

Payment Details Monthly Less that 131 Days

Section Break

Let's Continue

Please choose a Username and Password

IMPORTANT BILLING INFO - PLEASE READ CAREFULLY

SUMMER FUN CAMP 2019

Now Accepting Registrations

Saint Patrick’s Day: 2 Fantastic Events on 1 Day!

To reserve a space in a clinic, please call (954) 834-6287 24 hours prior to the class.

Please add me to your Tennis Mailing List