Sample Registration Form --- (Delete the Events Below that are not offered in your Tournament)
Good Guys Pickleball Tournament
Dates of Play: October 15, 16, 17 20XX
Events: women’s singles ____, men’s singles ____, women’s doubles ____, men’s doubles ____, mixed doubles____
Entry Deadline: Entries must be received by _________________________________________________.
Entry Fees: Entry Fees are $__________ for the first event and $__________ for each additional event.
Please make checks payable to _______________________________.
There is a $____ Discount to USAPA Members if you enter your USAPA Card Number below.
Mail To:
John Doe at Good Guys Pickleball Club at 15016 Good Guys Lane, Good City, AZ 99999
Location: Good Guys Pickleball Club at 15016 Good Guys Lane, Good City, AZ 99999
Format of Play: Indicate here whether events will be double or single elimination, round robin or have consolation rounds.
Gender (M or F): ____
Name: ___________________________________________________________________________
Last
First
middle initial
USAPA Member Number
Address: ________________________________________________________________________
City
State
Zip
Phone #:_____________________ Cell Phone #:__________________ Birth date: _____________
Email Address: _________________________________________________________________
Emergency Contact: _____________________________ Phone #: ___________________________
Total Money Enclosed With Your Entry: $_______________
---------------------------------------------------------------------------------------------------------I APPLY FOR ENTRY IN THE FOLLOWING EVENTS ---- (CIRCLE EVENTS AND CHECK BOXES)
Junior Singles | 18&U 16&U 14&U
Junior Doubles | 18&U 16&U 14&U
Junior Mixed | 18&U 16&U 14&U
Rated Singles | 5.0
4.5
4.0
Rated Doubles | 5.0
4.5
4.0
Rated Mixed
| 5.0
4.5
4.0
Young Adult/Adult/Senior Singles |
Young Adult/Adult/Senior Singles |
Young Adult/Adult/Senior Singles |
Open Singles |
Open Men's Singles
Open Doubles |
Open Men's Doubles
Partner's Name
12&U 10&U
12&U 10&U
12&U 10&U
3.5
3.0
3.5
3.0
3.5
3.0
19+
35+
50+
55+
19+
35+
50+
55+
19+
35+
50+
55+
Open Women's Singles
Open Women's Doubles
Partner's Phone
Boy
Girl
Man
Woman
.
.
60+
60+
60+
65+
65+
65+
70+
70+
70+
75+
75+
75+
Man
Open Mixed Doubles
Birth Date
USAPA Number
Doubles..: ___________________________ _______________ ______________________ ___________________
Mixed ....: ___________________________ _______________ ______________________ ___________________
Sign and date the waiver on the second page.
Woman
.
RELEASE, PERMISSION, AND INDEMNITY AGREEMENT
Waiver. In consideration of being permitted to participate in any way in the Good Guy Pickleball Tournament (“the Tournament”), I,
for myself, my heirs or assigns, do hereby release, waive, discharge and covenant not to sue [name of entity sponsoring tournament
and/or facility where the tournament is being held], 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 pickleball. 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 the Good Guy Pickleball Tournament [add others as
desired] harmless from any and all claims, actions, suits, costs, expenses, damages and liabilities, including attorney’s fees brought as
a result of my involvement in the Tournament.
Use Permission. I also give the Good Guy Pickleball Tournament 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 of Participant
__________________________________
Print Name of Participant
____________
Date
__________________________________
Signature of Parent/Guardian if Minor
__________________________________ ____________ _____________
Print Name of Minor’s Parent/Guardian
Date
Minor’s Age