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The
Bernard Master Junior Satellite Circuit
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Player Registration Form
| Name | ______________________________________________ |
| Birthdate | ______________________________________________ |
| Address | ______________________________________________ |
| City | ______________________________________________ |
| State/Zip | ______________________________________________ |
| E-Mail Address | ______________________________________________ |
| Phone Number | ______________________________________________ |
| Adult T-shirt Size | ______________________________________________ |
| Age Division (Circle) Based on your age as of June 30, 2009 | |
| Boys & Girls 10's (combined) | |
| Boys 12's | Girls 12's |
| Boys 14's | Girls 14's |
| Boys 16's | Girls 16's |
| Boys 18's | Girls 18's |
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Phone (Olympic Indoor): 614-267-1213 (ask for Jim Criswell for more information) ***Read and Sign Below*** Acceptance of my entry in this event is without assumption of responsibility of any kind by the Mid-Ohio Clubs listed, Michelle Parish, or Dr. Bernard Master, its officers, committees or management of any event in which I may be entered or participate. In consideration of the representatives and their successors and assigns, from any and all demands of every kind which I may or may hereafter acquire, for any and all damages, losses or injuries which I may sustain directly or indirectly in connection with said events, and all such claims are hereby waived and released and I covenant not to sue therefore.
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