INSCRIPTION FORM NAME : SURNAME : DATE OF BIRTH :... SEX : male female ADDRESS : POSTAL CODE : TOWN : COUNTRY :.. TEL :...././. TENNIS LEVEL For non-classified players : How long have you been playing tennis?..., How many hours a week do you practise on average?..., Have you played in tournaments :.., Your level is equivalent to the player classified as :. Your level : Beginner who has played a little, Average. LEVEL For classified players : Classification 2018 :.. DATE : From. To 2018 Licence number FFT*: *French Tennis Federation E MAIL* :.....@ *(Confirmation of reception will be sent by E Mail) 1
PARENTS AUTHORIZATION PARENTS NAME:... SURNAME : TRAINEE S NAME : SURNAME :.. ADDRESS : PHONE/ Mobile :.... House :.... E MAIL : @...... Medical information : Medical antecedents :.. Blood group : Allergies : Special mention :. 1 I, the undersigned, Mr. Mrs..authorize Monsieur FRANCK LEROUX to act on my behalf in case of emergency, medical care or hospitalisation. I agree to reembourse l Académie de tennis Franck LEROUX for any eventual medical, surgical, chemist costs and all the costs for taking care of my son or daughter. 2 Furthermore, I grant Franck LEROUX and his staff the permission to transport my child by all means of transport used (private or rented car, bus, taxi, train, boat) 3 Grant my child the authorization to take part in the proposed activities (especially swimming in the Bay or at the ocean) 4 I hereby certify that my child has a civil responsability insurance policy for any damage he or she might cause. Agreed in (name of your town) on. Signatures : (preceded by the mention «lu et approuvé» read approved ) 2
PAYMENT FEES :Intensif Course 5 days : 584 12 days : 1217 19 days : 1848 1 Down-payment : Cheque for 25% of Total Fee :.... 2 Airport Transfer : Transport costs for internet scheduled flights : return 40, one way 20, for all other flights, return 60, one way 30 : Total:. 3 Cancellation and Course Interruption Insurance yes no, 5 jours : 23, 12 Jours :46, 19 Jours : 69 Total:. 4 The photocopy of the 2018 licence (also available at the tennis club, it costs 20 ) 20, Total:. Total cost 25% of total fee + N 2,3,4 : If you to pay by bank transfer: (attention the expenses of transfer for countries except European community are at your expense) : MR FRANCK LEROUX REFERENCES BANCAIRES INTERNATIONALES: IBAN : FR49 3000 2018 3100 00021129L40 BIC :CRLYFRPP ADRESSE BANQUE: CREDIT LYONNAIS ARCACHON. 175 BD DE LA PLAGE 33120 ARCACHON. FRANCE As the parent or tutor of the enrolled child, I hereby certify that I have been informed of the general conditions of enrollment and paticipation in l Académie Franck Leroux and I agree to abide by these conditions. Signatures : (including the mention «lu et approuvé» - read and approved) The total fee must be paid 30 days (at the latest) before the course begins. There will be no confirmation by return post for the balance payment. 3
ARRIVAL AND DEPARTURE TIMES NAME : SURNAME :.. ARRIVAL : please note the precise date and time 1 Arrival at Arcachon la DUNE, 156 bd de la côte d Argent on the / /2018 at 5 P.M. 2 Arrival on Sunday in the S.N.C.F. railway station in Arcachon (we pick you up) the / /2018 at (time) Train N :.. 3 Arrival on Sunday in Bordeaux Mérignac Airport. We pick you up for all flights proposed on our internet travel site at a cost of 20 and all other flights (foreign) at a cost of 30 the / /2018 at (time) Flight N : DEPARTURE : tick the appropriate box ALL DEPARTURES ARE ON Saturday MORNING. Your parents pick you up at Arcachon,la Dune, 156 bd de la côte d Argent on the / /2018 at 5 P.M. We will take you to the station on Saturday morning (please precise your departure time) :.. You are picked up on Saturday morning the.. / /2018 at the tennis club, at the Dune Centre We take you to Bordeaux Mérignac Airport on Saturday morning at a further cost of 20 or 30 per person per trip the / /2018 departure time :... flight N.... 4
INTENSIVE TENNIS TRAINING COURSES (for under 18 s) WITH FULL BOARD AND LODGINGS AT ARCACHON TENNIS CLUB. 24-HOUR SUPERVISION 2018 1) Enrolment procedure ENROLMENT CONDITIONS: The following completed forms must be sent to the following address : ù The completed enrolment form ACADEMIE DE TENNIS FRANCK LEROUX, TENNIS CLUB D ARCACHON 7, avenue du Parc 33120 ARCACHON FRANCE Parents permission Photocopy of 2018 licence (if you haven t got a licence, you will be issued with one at the club. It costs 20 and it is valid for one year. A Doctor s Certificate which doesn t prevent the trainee from practicing competitive sport (At enrolment,download the example on tennisleroux.com and have it filled in and signed by your doctor.) A 25% down-payment, the balance must be paid, at the latest, 30 days before the beginning of the course Course cancellation or interruption Insurance is optional. This insurance covers sprains, muscle injuries, any sickness during the course etc (see conditions) For fuller information, consult the contract.. Arrival and departure form, as well as any eventual transport costs from Bordeaux Airport (40 or 60 the return trip) 2) Following your enrolment On reception of your enrolment, you will immediately receive confirmation by e-mail, on condition that the enrolment is received 3 weeks prior to the beginning of the course. 3) Complete Fee Payment Complete fees must be paid, at the latest, 30 days before the beginning of the course without any remainder on our behalf. 4) Cancellation Phone 06 19 56 01 45 and confirm by registered letter as soon as possible. If you cancel more than 30 days before the beginning of the course, you down-payment will be refunded, less 50. You lose your down-payment for any cancellation between 6 and 30 days before the beginning of the course. No refund for any cancellation within 3 days of the beginning of the course. No refund for any absence without prior notification. Trainees must pay the complete fee for any course which they have started. 5) Cancellation Guarantee Cancellation and Interruption Insurance is optional. It covers the costs of sprains, muscle injuries, tec with complete reemboursement, no matter what the cancellation date. For further information, see contract. 6) L Académie de tennis Franck Leroux The Academy reserves the right to cancel a course if the number of trainees is insufficient to form a group. Timetable notifications may be necessary for a more practical organization. When a course is cancelled by the Academy, all payments will be refunded. 7) Medical Costs In the case of sickness or accident, the Académie de Tennis must be refunded for all its medical expenditure within one month of the end of the course. 8) Community life As with the participation in any holiday camp, all rules and regulations must be strictly adhered to. Any unacceptable behaviour which threatens the physical or moral well being of others trainees, such as smoking, taking drugs, alcohol as well as robbery, are stricktly prohibited. Trainees may be expelled from the course for the non-respect of these rules, and parents will cover all transport costs and pay the complete course fee. 9) Photographs I hereby grant l the permission to use any photo of my child taken during the course for commercial and communication use. 5
ACCESS Insurance broker - ACE Europe Group Insurance coverage in case of cancellation and Interruption 2018 1. BEFORE THE INCEPTION OF THE TRAINING COURSE, the coverage include: - Serious illness, serious accident, death of the trainee or of a member of his family - Sprains, pulled muscles and any other ailment preventing trainee from playing tennis - Important material damage to personal belongings when physical presence is mandatory - Redundancy of the trainee, his father or his mother YOU WILL BE REIMBOURSED - 25% of the total fee, in case of the event insured occurs 30 days prior to the date of the beginning of the training course. - 100% of the total fee, in case of the event insured occurs within the 30 days of the beginning of the training course. 2. AFTER THE INCEPTION OF THE TRAINING COURSE, the coverage include: - Serious illness, serious accident, death in the family affecting a trainee or a member of his family - Sprains, pulled muscles and any other ailment preventing trainee from playing tennis - Important material damage to personal belongings when physical presence is mandatory - Redundancy of the trainee, father or mother You will be reimbursed pro-rata of the period insured starting from the date of the claim DEDUCTIBLES - Cancellation for any medical reason before the inception of the training course : 10% of the amount insured with a minimum of 50 - Others events insured : None EXCLUSIONS - NOT INCLUDED IN THE COVERAGE - Any disaster, damage or loss caused intentionally by the trainee (included suicide) - Accident, illness or death : occurring before the beginning of the coverage of the training course insurance policy, due to a chronic disease a mental illness or depression/nervous breakdown with hospitalization of less than 3 days. INSURANCE PREMIUM : 5 jours : 23, 12 Jours :46, 19 Jours : 69 IN CASE OF CLAIM: Please, Inform us within 48 hours SUBSCRIPTION FORMS (to be returned with the course enrolment form) For payment by cheque, please write at the order of ACCESS Assurances NAME : SURNAME :. ADDRESS: COUNTRY:... DATE OF TRAINING COURSE:... AMOUNT OF THE TRAING COURSE INSURED:. I enclose the fee of. Lu et approuvé (Read and approved) Signature: ACCESS ASSURANCES 11 rue du Professeur Delmas Marsalet 33200 Bordeaux Tel : 05 35 54 67 45 ou 06 78 60 28 53 ACE Europe France is a subsidiary of ACE Europe group limited based in London 6
Mandate to be completed for accommodation, FFT license 2018 or Access Insurance undersigned Mrs. Mr... (Name of student's parents) Gives warrant for his account to Mr Franck LEROUX: the organisation of his half-board accommodation at the "La Dune" at 156 BD de La Côte d'argent in Arcachon... (Date of the tennis course) Purchase of its FFT 2018 tennis license from the FFT or the Tennis Club of Arcachon (check only for foreigners) Purchase of the access insurance from Ace Europe Group (check only for foreigners) Date and signature 7