Geezer Meister Tournament 2013
Sponsored by the Pickleball Club of Spruce Creek Golf & Country Club
Del Webb Community, Summerfield, Fl 34491
Dates: January 17-18, 2013 If needed: January 19, 2013
Entry form must be received by January 11, 2013
Each player must submit his/her own entry form and signed waiver.
Mail check and SIGNED entry & waiver to: Jim Claycomb 12948 SE 90th Ct. Rd., Summerfield Fl 34491
Make checks payable to SCGCC PICKLEBALL CLUB
$13 entry fee per person per event ($12 for USAPA members)
Complimentary tee shirt for those that referee 2 matches
If you agree to referee state tee-shirt size _________________________
Name: _______________________USAPA #______________ Male or Female
Email Address ____________ Birthday ____________Phone _________
Name of community________________Street Address___________________
City:_________________________ State/Zip________________
Emergency Contact____________________Contact’s phone#____________
I apply for entry into the following events:
Thursday January 17, 2013 Circle the age group you wish to enter
Men’s Doubles: age 50+ 55+ 60+ 65+ 70+
Partner’s Name___________________________________________
Thursday January 17, 2013 Circle the age group you wish to enter
Women’s Doubles: age 50+ 55+ 60+ 65+ 70+
Partner’s Name ___________________________________________
Friday January 18, 2013 Circle the age group you wish to enter
Mixed Doubles: age 50+ 55+ 60+ 65+ 70+
Partner’s Name ___________________________________________
AGREEMENT * RELEASE AND WAIVER OF LIABILITY
In consideration of being permitted to participate in the Geezer Meister pickleball tournament at Spruce Creek Golf and Country Club, I the undersigned DO HEREBY:
1. RELEASE, WAIVE, FOREVER DISCHARGE, HOLD HARMLESS, AND COVENANT NOT TO SUE THE DEL WEBB SPRUCE CREEK HOA AND PICKLEBALL CLUB. )
2. INDEMNIFY AND HOLD HARMLESS: Release from and against any loss, liability, damage or cost that I or any of my guests may incur due to participation, involvement or presence at tournament, whether caused by negligence, action or inaction of Release or otherwise.
3. ASSUME FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE arising out of or in any way connected with the participation, involvement or presence by me and my guests at tournament event, whether caused by the negligence, action or inaction of Releases or otherwise. I understand there are risk of injury, death or property damage inherent in this activity or event, and I accept that risk freely and voluntarily.
4. AGREE that the forgoing release, waiver and indemnity agreement is intended to be as broad and inclusive as is permitted by Florida law, and that if any portion is held invalid for any reason, the balance should notwithstanding,
continue in full legal force and effect
I HAVE READ THE FOREGOING AGREEMENT IN ITS ENTIRETY AND I HEREBY FREELY AND VOLUNTARILY SIGN THIS AGREEMENT, INTENDING TO BE BOUND THEREBY.
_____________________________ ____/_______/___________
Partivcipants Signiture Date
