Name *

First Name

Last Name

Phone *

Please include area code

(###)

###

####

Date of Birth (optional)

MM

DD

YYYY

Emergency Contact *

Emergency Contact

First Name

Last Name

Emergency Contact Phone *

Please include area code

(###)

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By completing this application and typing my signature (first and last name) below, I accept the following: *

I recognize and understand that there are certain inherent risks to which I will be exposed because of the nature and level of the sports activity in which I have agreed to participate. I understand and agree that the Fairfield Pickleball Club, their agents, and officials assume no responsibility for injury or illness that I may sustain as a result of my physical condition or my participation in any Fairfield Pickleball Club activity or event. I understand it is my responsibility to provide my own accident and health coverage and that the Fairfield Pickleball Club, their agents, or officials, do not provide any accident or health insurance for participants or volunteers. I also give permission for the Fairfield Pickleball Club to use or distribute, without limitation or obligation, any pictures or other records of an event which may include my voice or image. I hereby, for my heirs, administrators and assigns, release, waive and hold harmless the Fairfield Pickleball Club, their agents, and officials from any manner of claims or lawsuits that may result from my participation in this sport.

In Addition, I agree to the Fairfield Pickleball Club Code of Conduct: I will treat others with respect. I will exhibit fairness and honesty in my dealings with others. I will support Fairfield Pickleball Club and USA Pickleball policies, procedures, plans and initiatives. I will not engage in unsportsmanlike conduct or encourage others to do so. I will not engage in any behavior that would endanger the health, safety, or wellbeing of others. I will not engage in the use of obscene language or gestures. I will accept responsibility for my own actions. I will exemplify the highest standard in ethical behavior and fair play. I will engage in conduct that is free from fear, discrimination, abuse, and harassment.