STATE SERIES I - Registration Form

STATE SERIES I

14Tth & 15th June at Beach Arena - Scarborough

Athlete Information

Player Name*

First NameLast Name

Date of birth *

Guardian / Parents Names*

First NameLast Name

Address*

Street Address

Street Address Line 2

City

Postal / Zip Code

Cell Phone*

E-mail*

example@example.com

Categories - Choose your category, you must choose one*

Open/ITFIntermediate/AdvancedBeginner

Events*

Men’s DoublesWomen’s Doubles

1 Event

$25.00AUD

Subtotal

$0.00AUD

Tax

$0.00AUD

Total

$0.00AUD

Payment Methods

Credit Card

Apple Pay

Do you have a doubles partner?*

YesNo

If you have a Doubles Partner please insert his/hers name here:

First NameLast Name

Interested in Volunteering while your team is not playing?*

Important Notes

· Dress appropriately.

· Keep the beach clean.

If you don't have a partner please send us an email to hello@beacharena.com.au

· Fees: payment here

We are here to develop players and let them have fun with the game of Beach Tennis, good sportmanship required.

Emergency Contact & Health Insurance Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Do you have any allergies, chronic illness, or medical conditions that would limit high level activtiy?*

YesNo

Please describe

Parental Permission For Emergency Treatment

In the event of illness or accident, I give my permission for emergency treatment by qualified medical personnel for my child, and I authorize the person in charge to take my child to:
I give consent for the facility to secure any and all necessary emergency medical care for my child.

Name of Physician / Emergency Medical Care Facility

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Release of Liability

Although the safety of all sport activities is the primary concern, outdoor sport activities at 1st BT WA Open facilities may cause injuries and/or death. I expressly assume the risk of injury, death, and/or illness arising from any cause, and agree to waive the right to pursue any claim against the organizers and the persons in charge.

I, the participant specified above, confirm that I read all the information above and I am in perfect health for the practice of Beach Tennis and I accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. I further agree to indemnify and hold harmless Beach Arena their principals, agents, trainers and volunteers from liability for the injury or death of any person(s) and damage that may result from my negligent or intentional act or omission while participating in activities offered by Beach Arena. This is includes but is not limited to parks, recreations area, playgrounds, area adjacent and/or area selected for Beach Arena for beach tennis practice.

Cancellation of registrations will be accepted until 20th of September 2022 with a 100% of the payment back. After 20th and before 27th of September 2022 the participant will received only 50% of the payment back. After 27th of September 2022 no refund will be received.

I have read and agree to the above conditions*

YesNo

Signature*