USTA Pacific Northwest Standard Entry Form

JUNIOR CHAMPS -  Entry limited to 1 singles, 1 doubles event. (Players must be qualified for this division).

Girls’  _____     Singles  _____     Age Group _______

Boys’  _____     Doubles _____     Age Group _______

Partner’s Name __________________________________

Need Doubles partner  _____

JUNIOR "A" - (Optional: Include Player Record form with entry for seeding consideration.)

Girls’  _____     Singles  _____     Age Group _______

Boys’  _____     Doubles  _____      Age Group _______

Partner’s Name __________________________________

Need Doubles partner  ______

ROOKIES

Girls’  _____     Singles  _____     Age Group _______

Boys’  _____     Doubles  _____     Age Group _______

Partner’s Name __________________________________

Need Doubles partner  _____

ADULTS - (Optional: Include Player Record form with entry for seeding consideration.)

Men’s  _____          Singles  _____      Age Group _______

Women’s  _____     Doubles  _____     Age Group _______

Partner’s Name ______________________________

                             Mxd Dbles  _____   Age Group _______

Partner’s Name ________________________________

                             NTRP  _____     NTRP Rating ______

Need partner:  Dbles  _____     MxdDbls  _____

                             Wheelchair  _____    

                             Open  _____  A B C D (men only)

                             Quad  _____ A B

WAIVER OF RESPONSIBILITY

MEDICAL RELEASE: I hereby consent to emergency medical and/or hospital service that may be rendered by or at accredited hospitals, by appointed physicians, in the event such need arises in the opinion of a duly licensed physician.

WAIVER AND INDEMNITY AGREEMENT: Acceptance of my entry in these events is without responsibility of any kind by the USTA/PNW Section and any other entity sponsoring the event. I do hereby for and on behalf of myself and my heirs and legal representatives RELEASE and forever discharge the USTA/PNW, its officers and representatives, from any and all claims, demands, and injuries, howsoever arising, whether caused by the negligent or intentional acts of the USTA/PNW 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/guardian by signing below, does hereby agree to INDEMNIFY and hold harmless the USTA/PNW Section 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/PNW, its representatives, or the sponsoring body. I HAVE READ AND UNDERSTAND THE FOREGOING RELEASE AND INDEMNITY AGREEMENT.

Signature (entrant) ________________________________ Date ________

Signature ________________________________________ Date ________ (of parent/guardian if entrant is a minor)