Intersectional

USTA NATIONAL JUNIOR CHAMPIONSHIPS
USTA & aesculapian Release
Please complete this USTA & Medical Release, polarity it, have your parent or protector sign it, and take the signed form with you to the USTA National Junior statute title you are entering. This form, signed by your parent or guardian and you, must be presented at on-site registration in order to participate in the resultant. Please use saturnine ink and print clearly.

diagnose: AGE DIVISION: (circle one) B18 B16 B14 B12 G18 G16 G14 G12
NAME OF EVENT:
ADDRESS: (street) (city) (state) (zip)
PHONE (home): ( ) PHONE (parent office): ( )
SECTION: USTA social station NO.: exp.date

USTA RELEASE: The USTA requires a signed release covering fire tout ensemble entrants in national USTA events. The release must be signed by the entrant and parent or guardian of whatever entrant who is a minor.
Acceptance of my entry in these events is without assumption or responsibility of any kind by the USTA, its sectional associates, committee 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 my legal representatives release and forever discharge the USTA, its officers, committees, and representatives and their successors and assigns, of and from any and all claims and damages, losses or injuries which may be suffered or sustained by me in connection with my activities during the period for which such permission is granted and any period traveling to and from the events described, and all claims are hereby waived and released, and I covenant not to serve therefor.

____________________________________________________ _________________________________________________
Signature of Entrant Signature of Parent or Guardian

____________________________________________________________

__________________________________________
date Street City State Zip

MEDICAL RELEASE: I hereby consent to the rendering of emergency first...If you want to drag a full essay, order it on our website: Orderessay



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