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USTA SOUTHERN SECTION JUNIOR TOURNAMENTS USTA Southern Section Medical Release Please complete this USTA Southern Section Medical Release sign it have your parent or guardian sign it and take the signed form with you to the USTA Southern Section tournament you are entering. This form signed by your parent or guardian and you must be presented at onsite registration in order to participate in the event. Please use black ink and print clearly. NAME AGE DIVISION NAME OF Tournament ADDRESS street city state zip PHONE home PHONE parent office SECTION SouthernUSTAMEMBERSHIPNUMBER exp*date release covering all entrants in USTA Southern Section events. The release must be signed by the entrant and parent or guardian of any entrant who is a minor. Acceptance of my entry in these events is without assumption or responsibility of any kind by the USTA Southern Section 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 Southern Section 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 sue therefore. Signature of Entrant Signature of Parent or Guardian Date Street City State Zip MEDICAL RELEASE I hereby consent to the rendering of emergency first aid and other medical procedures which at the time of injury or illness seems reasonably advisable. I further understand that I will be responsible for payment of any such medical procedures. In consideration of the acceptance of my entry I hereby agree to abide by all applicable rules and regulations and codes of the USTA Southern Section and/or the same as may be adopted by the tested for drugs pursuant to the provisions Thereof*. This form signed by your parent or guardian and you must be presented at onsite registration in order to participate in the event. Please use black ink and print clearly. NAME AGE DIVISION NAME OF Tournament ADDRESS street city state zip PHONE home PHONE parent office SECTION SouthernUSTAMEMBERSHIPNUMBER exp*date release covering all entrants in USTA Southern Section events. Please use black ink and print clearly. NAME AGE DIVISION NAME OF Tournament ADDRESS street city state zip PHONE home PHONE parent office SECTION SouthernUSTAMEMBERSHIPNUMBER exp*date release covering all entrants in USTA Southern Section events. The release must be signed by the entrant and parent or guardian of any entrant who is a minor. Acceptance of my entry in these events is without assumption or responsibility of any kind by the USTA Southern Section its sectional associates committee or the management of any event in which I may be entered or may participate.

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