Private Tennis Lesson with Tennis Pro Registration "*" indicates required fields Parent / Adult Name* First Last Phone*Email* Student Name*Person taking the lesson First Last Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Add the names of everyone taking the lesson on the reservation page. Must include at least one member on your account.Date of Lesson* MM slash DD slash YYYY Start Time of Lesson* Hours : Minutes AM PM AM/PM TENNIS PROGRAM LIABILITY WAIVER AND RELEASE*By registering for or participating in any tennis lessons, classes, clinics, camps, or related activities (“Activities”) offered by Highlands Tennis, I acknowledge and voluntarily assume all risks associated with tennis and physical activity, including but not limited to slips, falls, collisions, muscle strains, heat-related illness, property damage, and other injuries that may result in serious harm. I certify that I (or my child) am physically able to participate and agree to follow all safety rules and instructions provided by Highlands Tennis staff. To the fullest extent permitted under the laws of the Commonwealth of Virginia and the State of Maryland, I, for myself, my child, and our heirs, executors, and assigns, hereby release, waive, discharge, and covenant not to sue Highlands Tennis, its owners, instructors, employees, contractors, volunteers, and affiliated personnel (“Released Parties”) for any and all claims, liabilities, demands, or causes of action arising out of or related to participation in the Activities, including those resulting from the ordinary negligence of the Released Parties. I further agree to indemnify and hold harmless the Released Parties from any and all damages, losses, costs, or expenses (including attorney’s fees) arising from participation in the Activities or from any breach of this agreement. I authorize Highlands Tennis staff to obtain emergency medical care for me or my child if needed and accept full financial responsibility for such care. If registering a minor, I affirm that I am the parent or legal guardian, consent to the minor’s participation, and agree to all terms of this waiver on their behalf. I understand that by completing registration, I am waiving substantial legal rights and that this Waiver, Release of Liability, Assumption of Risk, and Indemnification Agreement is intended to be as broad and enforceable as allowed under Virginia and Maryland law. I have read and agree to the liability waiver and release.PaymentPayment Method* Credit Card ACH Transfer Pay cash or check at Highlands Private Lesson Price: Lesson with Tennis Pro (up to 4 people included)Subtotal $0.00 Processing Fee Price: $0.00 Total Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20262027202820292030203120322033203420352036203720382039204020412042204320442045 Security Code Cardholder Name ACH* Account Number SelectSavingsChecking Account Type Routing Number Account Holder Name Order Token