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Permission Waiver
Bring this completed form to your first day of training, participation will not be allowed without a signed waiver. There will not be exceptions.
Minors Name: (PRINT) Parents/Legal Guardian Name: (PRINT) Daytime Phone: Address: In case of emergency contact: Relationship: Family Physician: Preferred Hospital: Allergic to medication(s): Phone: Phone: Group Medical No. Childs Blood Type: Evening Phone:
(hereinafter referred to as "Minor"), hereby signs the foregoing Waiver and Release for and on behalf of said Minor and represent that I have the legal capacity and authority to act for and on behalf of said Minor. I do hereby covenant with Desert Champions LLC, Garden of Champions LLC, PM Sports Management Corporation and International Merchandising Corporation, each company of the IMG Group of Companies (collectively, the Releases) that I hereby indemnify and hold harmless Releases and any of their respective officers, staff, employees against them as a result of any insufficiency or my legal capacity or authority to act for and on behalf of said Minor in signing this Waiver and Release. I hereby authorize any licensed physical, emergency medical technical, hospital or other medical or health care facility to treat said Minor named herein for the purpose of attempting to treat or relieve any injuries received by said Minor arising out of or relating to the 2011 BNP Paribas Open tennis tournament. I authorize any such medical provider to perform all procedures deemed medically advisable in attempting to treat or relieve such injuries. I consent to the administration of anesthesia as deemed medically advisable. I realize, and appreciate, that there is a possibility of complications and unforeseen consequences in any medical treatment(s) and I assume any such risk for and on behalf of myself and Minor. IN WITNESS of my consent and agreement to the matters stated above, I have subscribed my signature below, members, affiliates, legal representatives, successors and assigns for any and all claims and liabilities assessed
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We understand the importance of following the BNP Paribas Opens Code of Behavior and acknowledge that consequences will be imposed if the Code of Behavior is not followed. Additionally, we understand that if we have any questions, we will contact BNP Paribas Open Ball Kids Program Director, Adam Jasick at 760.200.8200 or ballkids@iwtg.net.
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