Kirkbrae Program Registrations

You may register for any Kirkbrae Tennis Program by:

Completing the registration form on this page and mailing it to George Haley,
5 Elizabeth Ann Dr. Johnston, RI 02919
Clicking on the registrations tab on the left side of page.

Mail in the Kirkbrae brochure you received in the mail.

For further information you may contact me at coachhaley@cox.net
or call 401.487.2627.

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(highlight and print this section for your use as a registration form)

Junior / Adult Registration Form

Select the weeks that your youngster will participate.

June 28 ___ July 5___ July 12 __ July 19 ___

July 26 ___ August 2 ___ August 9 ___ August 16___

Fridays will be used for make-ups due to rain.
Call the club @ 333-1300 for rain cancellations or check my web site www.haleytennis.com (click on the Kirkbrae link).

Select Program Type

Youngsters

____ Beginner ____Developmental ____Intermediate ____ Advanced

Adults

____Adult Clinic

Child Name (1) _______________________________Age____Program code______

Child Name__________________________________Age____Program code______

Child Name (3) _______________________________Age____Program code______

Adult Name (1) _____________________________________ Program code______

Adult Name (2) _____________________________________ Program code______

Address __________________________________________

City/Town________________________________Zip_______

Telephone # ____________ Emergency# ________________

E-mail Address _____________________________________

Send Registration Form to: George Haley · 5 Elizabeth Ann Dr · Johnston, RI 02919

All fees must be included with this form.

No refund of registration fees will be given. No credit for missed clinics.

$_____________ Clinic fees ( refer to Kirkbrae program fees page)

$_____________ Tennis T-shirt $10 (optional)

$_____________ Beginner Racquet $25

$_____________ Amount

(Check / VISA/MC )

Method of Payment

Type of Card VISA or MC __________________

Account Number __________________________

Expiration Date ____________________________

Name as it appears on card _________________________________

Signature______________________________________