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SENIOR OLYMPICS - PICKLEBALL

Dates of Play: Fri/Sat/Sun July 10-12 Pickleball Tournament Open To Residents and Non-Residents of Hawaii
Events: Circle: Womens Doubles
Mens Doubles
Mixed Doubles (All Double Elimination)
Entry Deadline: Entries must be received by: Tuesday, June 30, 2015. Questions: www.kauaipickleball.shutterfly.com
Entry Fees: Entry Fees are $35.00 An additional fee of $5.00 if you wish to enter a second event.
Please make checks payable to: TennisCize
There is a $5.00 Discount to USAPA Members if you enter your membership # below.
Medals Awarded For First, Second, Third Place Winners
Mail To: TennisCize 75-5783 Niau Pl., Kailua Kona HI 96740
Check Payable To: TennisCize

Website: www.holuatennisandpickleballcenter.com

Gender (M or F): ____


Name: _________________________________________________________________Age:________
Last

First

middle initial

Address: ________________________________________________________________________
City

State

Zip

Phone #:_____________________ Cell Phone #:__________________ Birth date: _____________


Email Address (Important): ___________________________________________________________
Emergency Contact: _____________________________ Phone #: __________________________
Total Money Enclosed With Your Entry: $_______________ USAPA Membership #: _________
Please Circle Your T-Shirt Size: S M L XL XXL (shirts are mens sizes-order accordingly) No Shirt ______
I APPLY FOR ENTRY IN THE FOLLOWING EVENTS AND AGE GROUPS
Events: Circle: Womens Doubles
Mens Doubles
Mixed Doubles (All Double Elimination)
Circle Age Group: 50-54 / 55-59 / 60-64 / 65-69 / 70-74 / 75-79 / 80+
Friday - Mens Doubles; Saturday - Womens Doubles; Sunday - Mixed Doubles
You May Play DOWN In A Younger Division, But Not Up. Age Level Of Team Will Be Determined By Younger Player.
The Tournament Committee Reserves The Right To Combine Age Groups (Depending On Number of Entries)
Partner's Name

Partner's Phone

Birth Date

USAPA Number

Womens Doubles: _______________________ _____________________

_____________________ _______________

Mens Doubles:

_______________________ _____________________

_____________________ _______________

Mixed:

_______________________ _____________________

_____________________ _______________

Do You Need Partner? Let us know and we will do our best to find you one.
You will be asked to show Drivers license (address and birth date) when you register
All Players must check in 45 minutes before the scheduled start of your event

Important: Sign and date the waiver below (on the second page). Send Both Pages

WAIVER OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT


I, (enter your name)___________________________________________, the
undersigned and maker of this entry form, in consideration of being allowed
to participate in any way in the 2015 Hawaii Senior Olympics (Games), do
hereby acknowledge, appreciate, and agree that:
1.
The risk of injury from the activities involved in these Games is
significant, including the potential for permanent paralysis and death, and
while particular rules, equipment and personal discipline may reduce this
risk, the risk of serious injury does exist; and
2.
I knowingly and freely assume all such risks, both known and
unknown, even if arising from the negligence of the releasees or others, and
assume full responsibility for my participation; and
3.
I willingly agree to comply with the stated and customary terms and
conditions for participation. If, however, I observe any unusual
significant hazard during my presence or participation, I will remove myself
from participation and bring such to the attention of the nearest official
immediately; and
4.
I, for myself and on behalf of my heirs, assigns, personal
representatives and next of kin, hereby release and hold harmless
Kaho`omiki, (dba Hawaii Senior Olympics), their officers, directors,
officials, agents and employees, other participants, sponsoring agencies,
sponsors, advertisers, and, if applicable, owners and lessors of premises
used to conduct the Games ("releasees"), with respect to any and all injury,
disability, death, or loss or damage to person or property, whether arising
from the negligence of the releasees or otherwise.
I have read this release of liability and Assumption-of-Risk agreement, and
I fully understand its terms, understand that I have given up substantial
rights by signing it, and sign it freely and voluntarily without any
inducement.
Participant's
Signature__________________________Age:_______Date___________

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