P.O. Box 155, Irvington, NY 10533 - Ben Nisbet (Director)
Date Of Birth
Sitters/Guardians Allowed To Pick Up
WAIVER AND RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE I hereby enroll my child in participating in one or more Activity(ies) with AYTTO. I assume all risks associated with participating in this Activity(ies), including, but not limited to, falls, injuries, contact with other participants, spectators, others or equipment. Having read this waiver and knowing these facts, and in consideration of your acceptance of this application, I, for myself, my child and anyone entitled to act on our behalf, waive and release American Youth Table Tennis Organization (AYTTO), and all sponsors, representatives and successors, from all present and future claims and liabilities of any kind. I also grant permission of the foregoing persons and entities to use or authorize to use any photographs, motion pictures, recordings or any other record of my or my child’s participation in this Activity(ies) for any legitimate purpose without numeration.