T4 Teen Registration

* Indicates required field

Name of the Athlete *

First

Last

Birthdate *

School *

USAT Membership Number *

USAT Memb. Expir. Date *

Name of Parent/Guardian *

First

Last

Name of Parent/Guardian *

First

Last

Primary Email Address *

2nd Email Address *

Mobile *

2nd Mobile *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Special Needs *

Allergies *

Emergency Contact *

First

Last

Emergency Contact Phone Number *

Primary Doctor *

First

Last

Doctor's Phone Number *

Emergency Medical Care Release

In the event of an emergency involving my child and if the coaches cannot contact me, I hereby authorize any needed emergency medical care. I agree to assume full responsibility for all medical expenses incurred and to hold harmless and release from liability any and all parties involved with this training program.

I have read and agree *

Electronic Signature of Parent/Guardian *

Date *

I have read and agree *

Electronic Signature of Parent/Guardian *

Date *

Use of Image Permission and Waiver and Release

In consideration of my participation with the T4 Team, on behalf of myself and the child/teenager participant, I hereby grant the staff, it's officers, directors, employees, consultants, agents and successors a royalty-free, irrevocable, worldwide right to reproduce my and the child's/teenagers participant's likeness or image by photograph, video and any other means, and to use, publish, reproduce and distribute my and the child participant's name, voice, likeness, image and biography in whole or in part, in any medium, for any purpose in any manner and at any time.

Submit