South Carolina Medical Release Form 1
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USTA SOUTH CAROLINA TOURNAMENTS 
USTA South Carolina & Medical Release 

Please complete this USTA South Carolina & Medical Release, sign it and take the signed form with you to the USTA 
South Carolina tournament you are entering. This form, signed by your parent or guardian if under 18 and you, 
must be presented at on‐site registration in order to participate in the event. Please use black ink and print clearly. 

NAME: ____________________________________________________ 

AGE DIVISION: ____________________________________________ 

NAME OF EVENT:____________________________________________ 

ADDRESS:__________________________________________________ 
(street)                 (city)  (state)    (zip) 

PHONE(home):______________________ PHONE(work):_________________________ 
SECTION: Southern   
USTA MEMBERSHIP NUMBER:_______________________  (exp. date)_______________________ 

USTA SOUTH CAROLINA RELEASE: The USTA South Carolina requires a signed release