Junior Programs 2018-2019 Athlete Name* First Last Age (program options and cost will appear after age is selected)*Select your Age89101112131415161718Date of BirthMonth123456789101112Day12345678910111213141516171819202122232425262728293031Year2019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*PARENT INFORMATIONParent/Guardian Name* First Last Parent Email* Cell Phone*Emergency Contact other then Parent/Guardian* First Last Emergency Contact Cell Phone*Permission to photograph*Your child may be photographed during his or her training sessions. Your initials here indicate you agree to allow BBMPT to use his or her likeness on its website and in other marketing materials. If you would like to opt-out, please email Bob@BBMPT.com.Where did you hear about BBMPT?*Choose OneWord of MouthWeb SearchEmail ContactClifton Racquet ClubWardlaw-Hartridge SchoolOther-Please enter belowIf other - please tell us how?*What week/dates are you registering for?*SessionsJUNIOR PROGRAMJUNIOR F.L.I.P TENNIS PROGRAM (AGES 8-14)Wednesdays (4:30 - 6 p.m.) - Session 1- 12 Weeks October 17, 2018 - January 16, 2019Wednesdays (4:30 - 6 p.m.) - Session 1- 12 Weeks January 23 - April 10, 2019Sundays (11:30 a.m. -1 p.m.) - Session 1- 10 Weeks October 21, 2018 - January 13, 2019Sundays (11:30 a.m. -1 p.m.) - Session 1- 10 Weeks January 27 - April 7, 2019JUNIOR COMPETITIVE TRAINING PROGRAM (AGES 10-13)Mondays (5-7 p.m.) - Session 1- 12 Weeks October 15 - January 14, 2019Mondays (5-7 p.m.) - Session 2- 10 Weeks January 28- April 8, 2019HIGH SCHOOL PLAYERS TRAINING PROGRAMThursdays (4:30 - 6 p.m.) - Session 1- 11 Weeks October 18 - January 10, 2019Thursdays (4:30 - 6 p.m.) - Session 2- 10 Weeks January 17 - March 21, 2019Sundays (1-3 pm) - Session 1- 10 Weeks October 21 - January 13, 2019Sundays (1-3 pm) - Session 2- 10 Weeks January 27 - April 7 2019TOTAL PAYMENTTotal $0.00 How would you like to pay?*OnlineBy MailMailing AddressPlease mail payments to: Bob Bynum Match Point Tennis 19 Watchung Ave. West Orange NJ 07052
