Wheelchair Tennis Registration Form

Which dates are you attending?

Friday Nov 14, 6pm to 7:30pm, Sport Fit Bowie, 100 White Marsh Pk Dr, Bowie, MDSaturday Nov 15, 4pm to 5:30pm, Sport Fit Bowie, 100 White Marsh Pk Dr, Bowie, MDSaturday Nov. 22, 2:30pm to 4:00pm at the Navy Brigade Sports Complex, Annapolis

I am attending as

A wheelchair tennis participant, adultA parent/guardian with a youth wheelchair tennis participantAn interested party to learn to how to teach wheelchair tennisAn interested party to learn more about the sport

Please let us know if you are affiliated with any group or organization.

Participant/Attendee Name

FirstMiddle Last

Parent/Guardian if Wheelchair Participant is a Youth

FirstMiddle Last

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Participant/Attendee Phone

Participant/Attendee E-mail

example@example.com

The following questions are for wheelchair participants.

Others may skip to the end.

Wheelchair tennis participant

AdultChild

If child, please note age

Will you need to borrow a sports wheelchair? We have sports chairs available on a first come basis.

YesNoMaybe

If you need to borrow a sports chair, how wide is the seat? If you use an everyday wheelchair, you can measure your cushion for this information.

Are you an adult player who will require transfer assistance to the sports wheelchair?

YesNoMaybe

What is your level of experience with wheelchair tennis?

I haven't tried it but am excited to learn!I'm a beginner who has played a few timesI'm an intermediate level player who knows the basics of tennisI'm a tournament-level player in the C/D divisionOther

Are you a disabled veteran?

YesNo

If Yes, please indicate your branch of service

Disability-Specific Information
Please note that the following disability-specific information is collected to provide accessibility modifications that will ensure the best possible instructional environment for you or your child to learn tennis. Please complete this information at your level of comfort.

Optional: please provide more detail about the nature/type of disability. Please list the level if you have a SCI/D.

Optional: please provide any known modifications that would enhance your tennis-playing experience (ie tape to secure racket to hand, bench near the court to rest during breaks, etc) (text)

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 participation in these events is without responsibility of any kind by the Tennis Alliance of Anne Arundel County, Inc 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 Tennis Alliance AAC, its officers and representatives, from any and all claims, demands, and injuries, howsoever arising, whether caused by the negligent or intentional acts of the Tennis Alliance AAC and its representatives, volunteers, staff paid and unpaid, representatives of other sponsoring entities, or by third parties, which injuries may be in any way related to my activities during the event 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 Tennis Alliance AAC and its representatives and the sponsoring entity from any liability which they may incur to the participant, howsoever arising and whether caused by the negligent or intentional acts of the Tennis Alliance AAC, its representatives, or the sponsoring body.

TYPE YOUR FULL LEGAL NAME BELOW:
I have read and have understood this Release and Waiver. I understand by signing this Release, I have given up substantial rights. I have voluntarily signed this Release and Wavier. I am at least 18 years of age and I am competent to contract in my own name. I have read this Release and Waiver before signing below, and I fully understand the contents, meanings and impact of this Release and Waiver.

Signature

PUBLICITY RELEASE: I agree to be filmed and photographed by The Tennis Alliance AAC in connection with such participation and that the Tennis Alliance AAC will own any and all rights in such film and photography of me (hereinafter referred to as “Footage”). This will permit the Tennis Alliance AAC to proceed with taking such Footage and I now waive, as to the Tennis Alliance AAC 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 Tennis Alliance AAC will do so in full reliance on the foregoing permission.

Signature

Thank you and we look forward to seeing you!

Wheelchair Tennis Class Registration and Instructor Training Registration