Midwest Tennis Programs Registration Form

Last Name ______Mother’s Name______Father’s Name______

Address _______City______State______Zip______

Phone ______Email Address ______

Family Member Registration Information

Below register each member of your family for each class

Activity # / Program Name / Participant’s Last Name / Participant’s First Name / Sex
M /F / Age / Birth Date / Grade / Fee

WAIVER, RELEASE, AND HOLD HARMLESS AGREEMENT

Please read this form carefully. Be aware that in participating in any programs conducted or sponsored by Midwest Tennis Programs (MWTP), you will be waiving and releasing all claims for injuries or losses you might sustain arising out of or relating to the programs.

I am a participant, or a parent or guardian acting on behalf of a participant who is under the age of 18, in one or more programs conducted or sponsored by MWTP (the Programs). (The terms “I” and “my” refer to both the participant and the person, if any, who signs this document on the participant’s behalf.) I recognize and acknowledge that there are certain inherent risks of physical injury associated with the programs. I agree to assume the full risk of any injuries (including death), damages, or losses, regardless of severity or amount, which I may sustain arising out of or in connection with the programs. I agree to waive and relinquish all claims I may have, arising out of or in connection with the programs, against MWTP, any employees or independent contractors hired to direct ,manage, supervise, or teach the programs (collectively, “the program personnel”), and any of the foregoing persons’ agents employees, officers, board members, and attorneys. I do hereby fully discharge and release MWTP, the program personnel, and any of their agents, employees, officers, board members, and attorneys, from any and all claims, causes of action and liabilities of any nature for injuries (including death, damages, or losses which may be asserted against them arising out of or in connection with my participation in the programs. I further agree to hold harmless and indemnify MWTP, the program personnel, and any of their agents, employees, officers, board members, and attorneys from any and all claims, causes of action, and liabilities of any nature for injuries (including death), damages, or losses which may be asserted against them arising out of or in connection with my participation in the programs. .For good and valuable consideration, the Participant releases Midwest Tennis Programs, LLC, their officers, directors, employees, agents, and assigns permission to license and use all images and sound recordings in any media and for any purpose. The Participant agrees that Midwest Tennis Programs has all rights to images and sound recordings for perpetuity. This agreement is irrevocable, worldwide and perpetual

I hereby certify that I have read and fully understand the foregoing Waiver, Release, and Hold Harmless Agreement.

______

Participant’s Name Date

(Please Print)

______

Participant’s Signature

______

Parent or Guardian’s Name Date

(If participant is under age 18)

______

Parent or Guardian’s Signature