» Juniors

ATA Medical Release Form
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 on-site registration in order to participate in the event. Please use
black ink and print clearly.
NAME: AGE DIVISION: ______________________________________
NAME OF EVENT:________________________________________________
ADDRESS: __________________________________________________
                                          (street) (city) (state) (zip)
PHONE (home):______________________ PHONE____________________________ (parent office):
SECTION: _Southern_____USTA MEMBERSHIP NUMBER:_______________________ (exp. date)__________
USTA SOUTHERN SECTION RELEASE: The USTA Southern Section requires a signed 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, USTA ALABAMA or its Sectional/District 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 and USTA ALABAMA, 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
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/ALABAMA and/or the same as may be adopted by the USTA Southern Section/ALABAMA for this USTA Southern
Section/ALABAMA tournament, and hereby consent to be tested for drugs pursuant to the provisions
Signature of Entrant Signature of Parent or Guardian
Date Street City State Zip