Family Medical Release Form

This form must be completed and retuned with registration.

I hereby consent that the following members of my family:

Your Name	________________	Child 1	________________	Child 3	________________
Spouse	________________	Child 2	________________	Child 4	________________

may participate in the Princeton Tennis Program (the Program). All named family members are in good health and have been cleared by my physician to participate in the Program. I recognize that there are certain risks of physical injury inherent in participating in the Program. In order to minimize these risks, I/we (as listed) agree to obey all rules and regulations, follow all safety procedures and obey the management of the tennis facility and any and all members assigned to supervise the program. In case of an emergency regarding the above mentioned minor(s), I understand that every effort will be made to contact me (parent/guardian). In the event that I cannot be reached, I hereby authorize emergency medical care for my child while attending the Program, if in the judgment of the staff, treatment is required for an injury or illness. I understand the Program Staff will provide first-aid within their capacity to do so. In the event that my spouse or I have an emergency, I consent to medical treatment. I hereby authorize emergency medical care if, in the judgment of the Program Staff, treatment is required for injury or illness. I understand that the Program Staff will administer first-aid within their capacity to do so. I hereby give permission to the Program Director and the individuals whose names are set forth below to consent to proper medical treatment and hospital care, as well as recourse to procedures deemed necessary by the attending physician when the need for such treatment is immediate. I also give permission for my family members listed above and myself to be transported to the Medical Center of Princeton or in the event of an offsite emergency, the nearest available hospital. I understand that I am responsible for any expenses for medical care or transportation incurred by my family members or myself. The following persons may be called in the event of an emergency (including parent/guardian) in the following order:

1.	______________________________	Day Phone	___________________________
2.	______________________________	Day Phone	___________________________

I hereby release and hold harmless the Princeton Tennis Program and its employees, directors, officers, agents, volunteers and independent contractors from and against any and all actions, losses or claims of any kind of nature, which may arise as a result of an accident or injury suffered by a family member or myself while attending, participating in, or being transported to or from the tennis facility.

Signature: __________________________ Date: ________________________

Is there any medical condition we need to know about? (for example allergic to bees, asthma, etc.)