Name

First Name

Last Name

Year of birth

Phone number

(###)

###

####

How long have you played tennis?

Have you ever trained any other sport and for how long?

Do you play

Singles

Doubles

Both

What is your current USTA NTRP rating?

2.5

3.0

3.5

4.0

4.5

5.0

Do you have any medical condition/health concerns that might affect your participation in the Off-court Tennis Bootcamp (cardiovascular, respiratory, metabolic or any other medical condition)? Do you take any medication?

Do you currently have any sports injuries or pain?

Describe your injury (how it happened, location, type of pain, level of pain, and how long has it been bothering you).

Have you had any sports injuries before?

Describe the injury and the treatment (surgery, physical therapy modalities used, etc.)

Have you ever done strength and conditioning (sports performance) training? Describe your strength & conditioning experience (length of training, types of exercises, biomotor abilities trained, resistance training experience, intensity, equipment, etc.) .

The foundational biomotor abilities include (but not limited to): strength, endurance, speed, coordination, and flexibility. The derived biomotor abilities include (but not limited to): mobility, balance, power, and agility.

What are your strength and conditioning short-term and long-term goals?

For example: I want to improve my speed when turning and running for lobs.

Are you interested in:

Personalized training (1 athlete) $70

Personalized training in a small group (2-3 athletes) $40/person

Personalized training in a small group (4-5 athletes) $30/person

Camp type training in a large group (6-10 athletes) $20/person

Online training

What days and times would work the best for you?

Are you interested in receiving e-mails in regards to any programs, online courses, or camps/clinics organized by Dusica Dordevic?

Yes

WAIVER AND ASSUMPTION OF RISK I am aware that participation in the Off-court Tennis Bootcamp has some inherent risks and injury can occur. I authorize, without prior approval, the rendering of any emergency medical treatment that may become necessary due to my participation in the activities. I attest that I have no known medical conditions which prohibit participation in Off-court Tennis Bootcamp. I waive and release Dusica Dordevic from any and all actions, causes of the action, damages, claims, or demands of whatever kind or nature which I may have against her for any injuries, known or unknown, which are incurred by, arise from, or in any way relate to my participation in the Off-court Tennis Bootcamp. I will be responsible for any medical or other charges in connection with my involvement in the program. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury, including, but not limited to, personal injury, disability, and death, illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance in the Off-court Tennis Bootcamp. I understand that Dusica Dordevic is not responsible for any lost or stolen items. I grant and give Dusica Dordevic and Athleticare the right to use my photograph or image, with or without my name, both individually and in conjunction with other persons or objects for any and all purposes including, but not limited to, private or public presentations, advertising, publicity and promotion. I understand that a copy of this waiver of liability and disclaimer will not be provided to me unless I request it. I HEREBY ACKNOWLEDGE BY MY SIGNATURE THAT I HAVE READ, UNDERSTOOD, ACCEPTED, AND AGREED TO THIS DOCUMENT.

Please sign the waiver: