Culion Table Tennis Club Registration Form

Name

First NameLast Name

Birth Date

MonthDayYear

Gender

Shirt Size: From time to time we may order shirts. Sizing helps us plan.

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Information

Name

First NameLast Name

Phone Number

Area CodePhone Number

Parent / Guardian E-mail

example@example.com

Emergency Information

Emergency Contact's Name

First NameLast Name

Relationship

Phone Number

Area CodePhone Number

Alt. Phone Number

Area CodePhone Number

Does the athlete have any other allergies, chronic illness, or medical conditions? If yes, please describe.

WAIVER OF LIABILITY AND RELEASE OF CLAIMS

WAIVER OF LIABILITY AND RELEASE OF CLAIMS

In consideration of being allowed to participate in the activities organized by Culion Table Tennis Club, I, the undersigned, hereby acknowledge and agree to the following terms and conditions:

Physical Condition: I certify that I am in good physical condition and have no medical conditions that would prevent my safe participation in training activities. I agree to inform Culion Table Tennis Club of any changes in my health that may affect my ability to participate.
Rules and Guidelines: I agree to abide by all rules, guidelines, and safety instructions provided by Culion Table Tennis Club and its representatives. I understand that failure to comply with these rules may result in my removal from the club.
Emergency Medical Treatment: In the event of an injury or medical emergency, I authorize Culion Table Tennis Club and its representatives to seek and consent to emergency medical treatment on my behalf.
Photographic Release: I grant Culion Table Tennis Club permission to use photographs or videos of me taken during training and official game activities for promotional or educational purposes without compensation.

Consent and Release of Information

I, the undersigned, hereby grant permission to Culion Table Tennis Club to use and release certain information and media for promotional and educational purposes related to my participation in training/official game activities.

Consent for Use of Media:

I hereby grant Culion Table Tennis Club the irrevocable and unrestricted right to use, reproduce, and publish photographs, videos, or other media in which I may be included, for promotional and educational purposes. This includes, but is not limited to social media, promotional materials, and educational presentations.

Release of Information:

I authorize the release of my name, age, and general information related to my participation in Culion Table Tennis Club activities for promotional and educational purposes.

Duration of Consent:

This consent and release of information remain valid indefinitely, unless I provide written revocation to Culion Table Tennis Club.

Revocation of Consent:

I understand that I may revoke this consent at any time by providing written notice to Culion Table Tennis Club. However, revocation does not affect any actions taken by Culion Table Tennis Club before receiving such notice.

No Compensation:

I understand that I will not receive any compensation for the use of the information and media described in this consent.

Signature

Signatures Name

First NameLast Name