First Annual Fall Pickleball Tournament
Please Fax Registration Form and Release Agreement to 706-896-2772 or Print and Mail -or- Deliver to:
Benchmark Physical Therapy
1615 US HWY 17 Suite 9
Young Harris, GA 30582
Date of Play: November 7th, 2015. Start time is 10:00 am with 9:15 am registration.
Entry Deadline: October 30, 2015
Entry Fees: $20.00 per player. Any additional donations accepted as all proceeds will go to benefit the Towns County Food Pantry.
Please make checks payable to: Towns County Food Pantry
Location: Towns County Pickleball Courts (Across from the entrance to the Georgia Mountain Fairgrounds)
Format of Play: Round Robin Doubles (You'll be playing with a different partner each game), Beginner and Intermediate Divisions, Without regard to Age or Gender
Name: ___________________________________________________________
Address: _________________________________________________________
Phone# ________________Cell Phone # _________________DOB: ________
Email Address: ____________________________________________________
Emergency Contact: ___________________Phone# ______________________
Total Money Enclosed for your Entry: ____________________________
Please circle rating: 3.5 and Above (Intermediate) 3.0 and Below (Beginner)
Release, Permission, and Indemnity Agreement Waiver
In consideration of being permitted to participate in any way in The First Annual Fall Pickleball Open Doubles Round Robin, I, for myself, my heirs or assigns, do hereby release, waive, discharge and covenant not to sue the Georgia Mountain Pickleball Club and/or the Towns County Recreation Department and/or Center, Benchmark Physical Therapy, and/or all agents and representatives of Towns County, GA, and its/their officers, employees and agents from liability from any and all claims resulting in personal injuries, accidents or illnesses (including death) and property loss arising from my participation in the Tournament.
Assumption of Risk. Participation in the Tournament carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks vary, but include 1) minor injuries such as bruises, sprains and dehydration, 2) major injuries such as eye injuries, joint, bone or back injuries, heat stroke, heart attacks, and concussions, and 3) catastrophic injuries such as paralysis and death. I have read the previous paragraphs and I know, understand and appreciate these and other risks that are inherent in playing pickle ball. I assert that my participation is voluntary and that I knowingly assume all such risks.
Indemnification and Hold Harmless. I also agree to indemnify and hold harmless the First Annual Fall Pickleball Open Doubles Round Robin and its agents, the County Recreation Department and its Center, Towns County, Georgia, and all its/their agents and officers harmless from any and all claims, actions, suits, costs, expense, damages and liabilities, including attorney’s fees brought as a result of my involvement in the Tournament.
Use Permission. I also give the First Annual Fall Pickleball Open Doubles Round Robin and its agents and designees permission to use or distribute, without limitation or obligation, my image, name, voice, and words for any purpose connected with the Tournament, including promotional, marketing, training, informational, and archival uses.
Signature__________________________________ Date_________________
Printed Name of Participant__________________________________________
Age___________
Print Parent/ Guardian Name if Minor___________________________________
Signature Parent/Guardian ________________________________
Date:________________
