Atrium Health Wake Forest Baptist Brenner Children's Hospital Kids' Day

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Hosted by the Winston-Salem Open and USTA-North Carolina

Date: August 19, 2023*

Deadline to submit registration: August 18, 2023

Location:

Allegacy Federal Credit Union Stadium

475 Deacon Blvd

Winston-Salem, NC 27105

Times:

Ages 6-8 9:00am-10:30am

Ages 9-12 11:00am-12:30pm

Atrium Health Wake Forest Baptist Brenner Children's Hospital Kids' Day is a free event, but you must complete the registration.

All participants receive a complimentary tournament ticket.

With a donation of unused school supplies, parents, chaperones, and siblings may receive an additional tournament ticket.

Tickets are only valid for August 19, 2023.

*Inclement Weather: In the event of inclement weather, this event may be cancelled. We will notify all participants via email.

Email *

Parent/Guardian Name *

Parent/Guardian Phone Number *

Participant Information

First Name *

Last Name *

Age Group *

9:00-10:30am - Ages 6-8

11:00-12:30pm - Ages 9-12

Tennis History *

My son/daughter has never played or is a beginner

My son/daughter can serve underhand

My son/daughter can serve into the service box overhand

My son/daughter plays in USTA Jr. Team Tennis or Tournaments

Would your son/daughter be interested in being a ball person during the Winston-Salem Open? (must be 12 or older) *

Yes

Street Address *

City *

State *

Zip Code *

Please list any special dietary needs of the participant.

Waiver

I hereby expressly acknowledge that, by allowing registrant as a participant in the Atrium Health Wake Forest Baptist Brenner Children's Hospital Kids' Day on Saturday, August 19, USTA North Carolina, Winston-Salem Open and the host facility and their agents, employees, officers, directors and other representatives are not assuming any responsibility of any kind. In consideration of the acceptance of registrant’s participation in the Event, I do hereby on behalf of myself and my heirs and legal representatives release and forever discharge the USTA North Carolina, Winston-Salem Open, the host facility and their agents, employees, officers, directors and other representatives, successors and assigns from any and all claims or damages, losses or injuries arising out of or relating to registrant’s participation in the Event. All such claims, whether known or unknown, are hereby waived and released and I covenant not to sue thereon.

I further give consent to Atrium Health Wake Forest Baptist, USTA North Carolina, and Winston-Salem Open for the use of any image and/or likeness in any photograph taken during or in connection with the Event, for promotion, commercial or any other purpose. By checking this box, I agree to receive future communications from Atrium Health Wake Forest Baptist, USTA North Carolina, and Winston-Salem Open. I consent to all such uses without any further compensation or other consideration becoming due. As this consent will be acted upon forthwith, it is irrevocable.

Waiver Consent *

I consent

Chaperone Agreement

Every child must be accompanied by a chaperone who is at least 18 years of age.

No more than 10 children per chaperone.

Chaperone Name *

Emergency Contact Name *

Emergency Phone Number *

Are there any participants you wish to be in the same group with? For example: friends, classmates, siblings, etc. Please list them below.

**Reminder: Each participant will need to register individually**

A copy of your responses will be emailed to the address you provided.

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