ETSC MEDICAL RELEASE FORM

ELSAWY TENNIS AND SPORTS CENTER LLC.

APPROVAL AND MEDICAL AUTHORIZATION AND RELEASE

FOR WATERCHASE TENNIS AND SPORTS DEVELOPMENT PROGRAMS

I hereby certify that ____________________________ (player) has my approval to participate at home or away from home in Tennis and Sports Development Programs conducted by ELSAWY TENNIS and SPORTS CENTER (ETSC) and WATERCHASE TENNIS (WT) for this year and subsequent years, unless I give written notice to the contrary. I understand and agree that the ETSC and WT and its employees, coaches and agents, assume no responsibility of liability for any accident or injury as a result of any aspect of participation in Tennis and Sports Development Programs. I understand and acknowledge that participation in Tennis and Sports Development Programs creates the potential for receiving an injury. With the knowledge of this potential risk of injury, I am giving myself and son/daughter (if applicable) permission to participate and accept full responsibility for this decision. In the event of an injury, permission is hereby granted to ETSC and WT representatives to render, secure, and/or authorize necessary medical treatment without further authorization from me. I understand that I will be responsible for payment of all medical expenses for injuries, and such payments do not waive ETSC and WT from general immunity or create any liability for injuries or damages.

First Name *
Last Name *
Email Address *
Emergency Contact Name*
Emergency Contact Number*
I have read and Agree to ETC medical release.
Signature (Parent If Minor)
Date (M/D/Y)
Allergies or Comments *