USTA/Pacific Northwest Player Waiver
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 the duly licensed physician.
WAIVER AND INDEMNITY AGREEMENT: Acceptance of my entry in these events is without responsibility of any kind by the USTA/Pacific Northwest Section (USTA/PNW) 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 or 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.
PUBLICITY RELEASE: I agree to be filmed and photographed by The United States Tennis Association (“USTA”) in connection with such participation and that the USTA will own any and all rights in such film and photography of me (hereinafter referred to as “Footage”). This will permit the USTA to proceed with taking such Footage and I now waive, as to the USTA and its successors, assigns and licensees, all personal right and objections to any use to be made of me, my name, likeness, voice or personality in connection with the use of the Footage in any media for any and all purposes, including trade, advertising and promotional purposes, in perpetuity and without further compensation. I understand that in proceeding with filming and photography of the Footage, the USTA will do so in full reliance on the foregoing permission.
I HAVE READ AND UNDERSTAND THE FOREGOING RELEASES AND INDEMNITY AGREEMENT
_______________________________________________________________________________
Print Name Team Name
_______________________________________________________________________________
Signature of entrant Date
_______________________________________________________________________________
Signature of parent/guardian Date
Emergency contact Name & Number __________________________
This form is to be turned in to your Team captain/coach prior to the start of tournament.