Pickleball Clinic Registration Form

Required fields are marked with asterisks (*)

Welcome to Pickleball Clinics Registration!

Please fill out the form below to register for the Town of Shelburne’s Pickleball Clinics with our expert coach, Jerry. Whether you're new to the game or looking to sharpen your skills, we’ve got a clinic for you!

Adult Clinics (18+) - $30.00

Sunday, Sept 28 | 9:00–11:00 AM
Sunday, Oct 5 | 9:00–11:00 AM

Register and pay in person at Town Hall by 4 PM the Thursday before each clinic.
Rain date: Sunday, Oct 19 (same times)

Youth Clinics (Free!)

Ages 8–12: Sunday, Sept 28 | 11:00 AM–1:00 PM
Ages 13–17: Sunday, Oct 5 | 11:00 AM–1:00 PM

Rain date: Sunday, Oct 19 (same times)

Participant Information

Participant First Name

Participant's Last Name

Participant's Date of Birth (Month/Day/Year)

Address

Postal Code

Participant or (Parent or Guardian if participant is under 18) Phone Number

Email Address?

Emergency Contact

Name

Phone Number

Relationship

Clinic Details

Preferred Clinic Date/Session

Both Dates Sunday, Sept 28 | 9:00 – 11:00 AM and Sunday, Oct 5 | 9:00 – 11:00 AM - $60.00 (including HST)

Sunday, Sept 28 | 9:00 – 11:00 AM - $30.00 (including HST)

Sunday, Oct 5 | 9:00 – 11:00 AM - $30.00 (including HST)

Consent and Waiver

Waiver and Release of Liability

By signing below, I acknowledge and agree to the following:

I understand that participation in pickleball and related activities involves inherent risks of injury, illness, or property damage.
I hereby release and hold harmless the Town of Shelburne, its staff, volunteers, and instructors from any and all liability for injuries, loss, or damage incurred during participation.
I voluntarily assume all risks associated with my participation in this clinic.
I release and hold harmless the Town of Shelburne, its staff, volunteers, and representatives from all liability, claims, or demands arising from my participation.
I confirm that I (or my child, if registering for a youth clinic) am physically able to participate in the clinic.
I authorize medical treatment in the event of an emergency if I or my emergency contact cannot be reached.
I grant permission for photos/videos taken during the clinic to be used for promotional purposes by the Town of Shelburne.
I have read and understood the above waiver and agree to its terms.

By signing below, I confirm that I have read and understood the above waiver and agree to its terms.

Signature of Participant (or Parent/Guardian if under 18)

Clear