Brenner Children's Hospital Kid's Day Registration
Deadline to Submit Form: August 18, 2017
Each age group is limited to 150 participants.

Date: August 19, 2017

Location:
Wake Forest Indoor Tennis Center
100 W. 32nd Street
Winston-Salem, NC 27105

Times:
Ages 6-8 9:30am-11:00am
Ages 9-12 11:30am-1:00pm

Inclement Weather: In the event of inclement weather, this event may be cancelled. We will notify all participants via email.

Brenner Children's Hospital Kid's Day is a free event, but you must complete the registration. All participants will receive a tournament ticket. With a donation of unused school supplies parents, chaperones, and siblings may receive an additional tournament ticket. Tickets are only valid for August 19, 2017

Participant Information
First Name
Your answer
Last Name
Your answer
Age Group
Required
Gender
Tennis History
Required
Street Address
Your answer
City
Your answer
State
Your answer
Zip Code
Your answer
Phone
Your answer
Email
Your answer
Please list any special dietary needs.
Your answer
Waiver and Consent
I hereby expressly acknowledge that, by allowing registrant as a participant in the Brenner Children's Hospital Kid's Day on Saturday August, 19th, USTA North Carolina, Winston-Salem Open and the host facility and their agents, employees, officers, directors and other representatives are not assuming any responsibility of any kind. In consideration of the acceptance of registrant’s participation in the Event, I do hereby on behalf of myself and my heirs and legal representatives release and forever discharge the USTA North Carolina, Winston-Salem Open, the host facility and their agents, employees, officers, directors and other representatives, successors and assigns from any and all claims or damages, losses or injuries arising out of or relating to registrant’s participation in the Event. All such claims, whether known or unknown, are hereby waived and released and I covenant not to sue thereon.

I further give consent to USTA North Carolina and Winston-Salem Open for the use of any image and/or likeness in any photograph taken during or in connection with the Event, for promotion, commercial or any other purpose. I consent to all such uses without any further compensation or other consideration becoming due. As this consent will be acted upon forthwith, it is irrevocable.

Waiver
Required
Chaperone Agreement
Every child must be accompanied by a chaperone, age 18 or over.

No more than 10 children per chaperone.

Name of Chaperone
Your answer
Name of Parent or Guardian
Your answer
Emergency Contact
Your answer
Emergency Contact Number
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Wake Forest University. Report Abuse - Terms of Service - Additional Terms