Louisiana Medical Release Form 2
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USTA-LOUISIANA JUNIOR TOURNAMENTS
USTA-Louisiana Medical Release
Please complete this USTA-Louisiana Medical Release, sign it, have your parent or guardian sign it, and take the signed
form with you to the USTA-Louisiana tournament you are entering. This form, signed by your parent or guardian and you,
must be present at on-site registration in order to participate in the event. Please use black ink and print clearly.
AGE DIVISION: (circle one) B18 B16 B14 B12 G18 G16 G14 G12

NAME:
NAME OF EVENT:
ADDRESS: (street)

(city)

PHONE (home):
SECTION:

(state)

(zip)

PHONE (parent office):
USTA MEMBERSHIP NUMBER:

(exp date)

RESIDENCY REQUIREMENTS:
Only players who have established a legal residency in the state of Louisiana, hold a current USTA membership card
assigned to Louisiana, and are citizens of the United States or meet the resident alien requirements for a USTA National
ranking are eligible to participate in any Louisiana closed tournament including Louisiana Junior qualifying.