Toledo Pickleball Glass City Invitational

Friday, Saturday & Sunday, July 17-19, 2015

Women’s Doubles* & Men’s Singles* (Friday) | Mixed Doubles* (Saturday)

Men’s Doubles* & Women’s Singles* (Sunday)

Double Elimination; USAPA Rules; Doubles Skill Levels: 3.0, 3.5, 4.0, 4.5, 5.0; Singles (Open)

LOCATION: Toledo Pickleball Courts, Just north of the US Post Office at 313 Glenwood Rd, Rossford, OH

REGISTRATION FEE: $30.00 ($10 for each doubles events, $5 for singles)—nonrefundable,

includes dri-fit shirt, water, snacks

Registration deadline: Must be postmarked by July 6, 2015.

Tournament Schedule: Registration Begins at 8:00 am, Play Begins at 9:00 am

* Event draws will be limited. In the event of inclement weather, matches may be held indoors.

Tournament Director: Connie Mierzejewski, 419-509-3023, bucksrgr8r@aol.com

Make checks payable to: Toledo Pickleball Club, ($30 registration fee, $10 for each doubles events, $5 for singles.)

Clip this entry form above at the line above and mail it no later than July 6th to:

Toledo Pickleball Glass City Invitational, c/o Connie Mierzejewski, 228 Hillsdale Ave., Rossford, OH 43460

ENTRY FORM - PLEASE PRINT

Name: ______________________________________________________________________________ Shirt Size: S M L XL XXL

Address: ____________________________________________________________________________________________________

City/State/Zip: _______________________________________ Phone: ____________________________________________

Email: ____________________________________________________________________________________ Gender: M __ F __

Singles: ___ Skill Level: ____ | Doubles: ____ Skill Level: ____ | Mixed Doubles: ____ Skill Level: ____

* (Please indicate your gender, the event(s) you are playing in and your skill level in the spaces above.)

Doubles Partner’s Name: ___________________________________________ Doubles Skill Level: _____

Mixed Doubles Partner’s Name: ___________________________________________ Mixed Doubles Skill Level: _____

PLEASE SIGN, DATE & RETURN THE WAIVER RELEASE FORM ON THE BACK OF THIS FORM

LIABILITY WAIVER

I, __________________________________________________________________________________________________________

Name (Please Print)

Home address:

________________________________________________________________________________________________________________________

Street City State Zip

acknowledge that I am aware that certain risks are or may be associated with activities sponsored by the Toledo Pickleball Club, and I personally

assume all such risks for the participation of myself in any activities in which I take part. I assume full responsibility to become educated regarding

the proper and safe use of any equipment associated with the activities in which I am involved, and the responsibility to abide by all safety rules

promulgated by the Toledo Pickleball Club in relation to said activities. I likewise assume full responsibility to obtain medical clearance from my

physician to participate in the activities offered by the Toledo Pickleball Club. In consideration of the permission granted to me by the Toledo

Pickleball Club to participate in the activities it sponsors, I hereby release the Toledo Pickleball Club and their agents, consultants or employees

from all actions, causes of action, damages, claims or demands which I or my heirs, executors or assigns may have against these entities/persons

for all injuries or property loss or damage which I may incur by participating in said activities.

I have read this informed consent/release of claims and understand its terms. I execute it voluntarily and with full knowledge of its significance.

In witness whereof, I have executed this release this ___________ day of _________________________________ in the year 2015.

__________________________________________________________________

Adult Guest Signature