*Student Name:

*Student Signature (Type):

*School:

*Date Of Birth:

    *Age:     *Grade:

*Address:

*City:

     *State:     *Zip:

*Home Phone:

     Alt. Phone:

Email:

ALL COMMUNITY SERVICE HOURS WILL BE SENT TO THE ADDRESS ABOVE

  *Division: 

Waiver, Indemnity, Assumption of Risk and Emergency Realease and Agreement must be signed and returned, before all students will be permitted to volunteer. 

It is the responsibility of the Parent/ Legal Guardian to insure that your child arrives at and is promptly picked up from the Youth League Tennis (YLT) site.  I hereby acknowledge that YLT may use a photograph and/or likeness of the named individual.  I consent to such uses and I hereby waive any and all rights to compensation for such uses.    In addition, I hereby give my permission for the named individual to volunteer their time for YLT  in exchange for community service hours. 

*Parent/Guardian Typed Signature:

*Date:

WAIVER AGREEMENT

In consideration of being permitted to participate in any way in Youth League Tennis (YLT) I, for myself, my heirs, personal representatives or assigns, do hereby release, waive, discharge, and covenant not to sue YLT, its officers, employees, and agents from liability from any and all claims including the negligence of YLT, its officers, employees and agents, resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to participation in YLT.

Assumption of Risk:  Participation in YLT carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries.  The specific risks vary and range from minor injuries such as scratches, bruised, and sprains to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks and concussions to catastrophic injuries including paralysis and death.

I have read the previous paragraphs and I know, understand, and appreciate these and other risks that are inherent in YLT.  I hereby assert that my participation is voluntary and that I knowingly assume all such risks.

Indemnification and Hold Harmless: I agree to defend, indemnify, and hold harmless YLT from and against any and all loss, liability charges, actions, claims, suits,  and expenses (including attorneys fees) and cost which may arise by reason of participation in YLT.  (YLT does not provide any insurance for program participants).

RELEASE AUTHORIZATION FOR EMERGENCY TREATMENT:    I understand that I am required to maintain and carry accident medical insurance coverage for the child listed on their application and I verify that the coverage information attached herewith is accurate and true.  As parent/guardian, I hereby consent to emergency treatment of my minor child as a result of accident or injury.
I further agree to pay any and all costs incurred as a result of said treatment.  I further agree to expressly assume the risk of my minor child participating in YLT.

I am the parent/guardian of the minor* and I am signing this release on behalf of said minor.

I HAVE READ THE ABOVE EMERGENCY AUTHORIZATION, WAIVER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT, fully understand its terms and understand that I am giving up substantial rights by agreeing to these terms, including my right to sue.  I acknowledge that I am signing the agreement freely and voluntarily,  and intend by my signature and agreement to be a complete and unconditional release of all liability to the greatest extent allowed by law.

*Parent/Guardian Typed Signature:

    *Date:

*Parent Phone:

Parent Alt. Phone: