CCITC NATIONAL "LIVING HEALTHY"
SENIOR TEAM TENNIS "DOUBLES" TOURNAMENT
ccitc@cromartytennis.ca [Defunct]
VOLUNTARY CCITC "LIVING HEALTHY" TENNIS CLINIC REGISTRATION FORM
(PLEASE PRINT ALL INFORMATION)
YOUR LAST NAME: __________________________________________________
YOUR FIRST NAME: ___________________ INITIAL: _______________
YOUR MAILING ADDRESS: ________________________________________
CITY/TOWN: ______________ PROVINCE/TERRITORY: _________________
POSTAL CODE: _______________________________________________________
HOME PHONE: ___________________ CELL PHONE: ___________________
YOUR E-MAIL: ______________________________________________________
GENDER: M: ____ F: ____
AGE AS OF NOVEMBER 19, 2014: ___________
SELF-IDENTIFIED TENNIS CANADA RATING (3.0 or Less): ___________
* ** 2014 SANCTIONED CANADA 55+ ASSOCIATION PLAYER: Yes: ________ No: _______
DATE MAILED: _____________
----------------------------------------------------
WAIVER OF LIABILITY
FORM
(DON'T FORGET TO SIGN THIS FORM AT THE BOTTOM)
NAME OF TENNIS CLINIC PARTICIPANT: ______________________________________
IN CONSIDERATION of my participation as a voluntary tennis clinic
participant at the annual CCITC
NATIONAL "LIVING HEALTHY" SENIOR TEAM TENNIS "DOUBLES" TOURNAMENT,
CBRM, Cape Breton Island" (hereafter
cited as "said CCITC Tennis Tournament"), and of my use of facilities associated
with the tournament, I do hereby waive, release and forever discharge the CCITC,
the Cape Breton Regional Municipality, and all respective officers, agents,
employees, representatives, executors, and all others from any and all
responsibilities or liability for injuries or damages resulting from my
participation in any voluntary tennis clinic at the "said CCITC Tennis
Tournament," or in any related activity, including but not limited to:
practices, competitions, meetings, travel, and social events.
I UNDERSTAND that my clinic participation at the "said CCITC Tennis
Tournament," is strictly voluntary, and that I assume the risk for harm or
injuries caused by such participation. I have been strongly advised that I
should have sufficient insurance coverage.
SINCE PARTICIPATION in Physical activity may involve increased risk or
personal injury, I hereby acknowledge that participation in any voluntary tennis
clinic at the "said CCITC Tennis Tournament," often involve exposure to risks of
injury, minor to serious, including permanent disability a/o death. These type
of injures may result from my own actions or inactions of others, or a
combination of both. IT IS RECOMMENDED that I consult with a physician prior to
participating in physical activity. I do hereby declare myself to be physically
sound and suffering from no condition, impairment, disease, infirmity, or other
illness that would prevent or impair my participation in any voluntary tennis
clinic activities at the "said CCITC Tennis Tournament," a/o facilities a/o
equipment. I do acknowledge that I have been informed of the recommendation for
a physician's approval prior to my voluntary tennis clinic participation at the
"said CCITC Tennis Tournament." I acknowledge that I have either had a physical
examination and have been given my physicians permission to participate, or that
I have decided to participate without the approval of my physician and do assume
all responsibility for my actions.
MY SIGNATURE certifies that I understand and accept the conditions
required for participation at the "said CCITC Tennis Tournament."
Signature: _____________________________________ Date: ____________________
MAIL TO: Eric Krause, Chair, CCITC, 62 Woodill Street, Sydney, Nova Scotia, B1P 4N9. (Please note: This is a free clinic - No charge)