|
USTA Southern Section Jr Team
Tennis Championships
Only originals can be accepted and should be turned in
during
the onsite tournament registration.
Player’s Name
State Age/Division
Parent or Guardian
Name
Contact #
Consent & Waiver Form
Consent to Communications: I
understand that by providing my mailing address, email address,
telephone number, and fax number, I consent to receive
communications sent by or on behalf of the USTA Southern, its
member organizations, and their representatives, via email or
fax.
Signature of parent/guardian (must be over
18):_______________________Date: ________
Consent to Publication.
I
hereby give the USTA Southern, its member organizations, and
their representatives the irrevocable right to use my name,
picture, photograph, or other likeness in all forms and media,
and in all manners. This includes but is not limited to print
and the web. I waive the right to inspect or approve the
finished version (s), including any written copy that may
accompany it.
Signature of parent/guardian (must be over
18):_______________________Date: ________
Medical Release: I
hereby consent to emergency first aid and other medical
procedures, or hospital service that may be rendered by or at
accredited hospitals, by appointed physicians, which at the time
of injury or illness seem reasonably advisable.
Emergency Contact Information:
Name _________________________________ Home Phone
_________________
Work Phone ____________________________ Cell Phone
___________________
Signature of parent/guardian (must be over
18:
________________________________Date: ________
Waiver and Indemnity Agreement:
Acceptance of my entry in these events is without responsibility
of any kind by the USTA, the USTA Southern, the host clubs,
committees, or the management of any event in which I may be
entered or may participate. In consideration of the acceptance
of my entry, I do hereby for and on behalf of myself and my
heirs and legal representatives release and forever discharge
the USTA Southern, the host clubs, their officers, committees,
and representatives and their successors and assigns, of and
from any and all claims, demands, and injuries, however arising,
whether caused by the negligent or intentional acts of the USTA
Southern and its representatives, representatives of other
sponsoring entities, or by third parties, which injuries may be
in any way related to my activities during the tournament and
any period traveling to or from the events described, and all
such claims are hereby waived and released, and I covenant not
to sue therefore. The parent or guardian, by signing below, does
hereby agree to indemnify and hold harmless the USTA Southern
and its representatives and the sponsoring entity from any
liability which they may incur to the entrant, howsoever arising
and whether caused by the negligent or intentional acts of the
USTA/STA, its representatives, or the sponsoring body. I
understand that this tournament will be governed by applicable
USTA rules and regulations, the rules and regulations of this
tournament, the rules and procedures governing discipline of
players in USTA Southern sanctioned tournaments, the USTA
Southern code of ethics, tournament policy, and ranking
regulations and agree to conduct myself accordingly.
I
have read and understand the foregoing releases, waivers and
indemnity agreement.
Signature of parent/guardian (must be over
18:|
________________________________Date: ________
Only originals can be accepted and should be turned in
during
the onsite tournament registration. |
