Smoky Mountain Athletic Club

2019/2020 Academy Registration

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Parent / Guardian / Emergency Contact #1

Parent / Guardian / Emergency Contact #2

We have read and agree to the Release and Authorization to publish notice.

Release / Authorization to Publish

I hereby give Tennessee Rugby Academy (TNRA) full, unrestricted rights to publish, distribute electronically and/or use any still or motion pictures, of me for use in editorial content, art, advertising, trade or any other lawful purpose. I understand my likeness may be used in advertising and/or promotions. I hereby release and hold harmless the Tennessee Rugby Academy and the Smoky Mountain Athleti Club , its successors, employees, agents, and assigns from any liability or claims of damage whatsoever in connection with said use of my likeness. I waive any right to inspect and approve final use of materials covered hereunder. I certify that I am 18 years of age, or if a minor, have included my parent or legal guardian, whose name appear within. I have read and understand this release, and certify that the information provided is true and accurate.