Burkettsville Community Picnic 9th Annual CO-ED Mud Volleyball Tournament

July 28th, 2012 @ 10:00 a.m. Team Name: (please print)____________________________________ Captain___________________________________________________ Address____________________________________________________
Street City State Zip

Phone Number______________________________________________ Captains Signature___________________________________________ Mud Volleyball Waiver

All mud volleyball participants must sign this liability waiver. Any individual whose signature does not appear on this form will not be allowed to participate, and therefore disqualifies that individual from competition.
In consideration of my participation in Mud Volleyball competition, the undersigned independently and collectively, and on behalf of him/herself, their heirs, personal representatives, and all those claiming by or through him/her, consent to, and does hereby, discharge, release, and hold blameless the Burkettsville Picnic Committee and all the sponsors and affiliates, servants, employees, agents, assigns, and successors from any all claims, actions, damages, or expenses for personal or bodily injury (including death) and property loss or damages incurred by him/her or arising out of or in connection with her/his participation on the above mentioned Mud Volleyball Tournament to be held at the Burkettsville Park. I hereby grant the Burkettsville Picnic committee and its legal representatives and assignees the irrevocable and unrestricted rights to use and publish photographs of me, or in which may be included, for editorials, trade, or advertising and nay other purpose and in any other manner or medium. I hereby release the Burkettsville Community Picnic Committee and its legal representatives and assignees from all claims and liability to said photography.

I have read the forgoing and am of age to consent to this waiver. If you are under age, your parents must also sign this paper by your name giving you (the under age) permission to participate in the above activity. Also, by signing this paper you are also releasing all personal and bodily injuries from the Burkettsville Community Picnic Committee and its legal representatives from all liability. Underage people must also provide their home phone number.

TEAM MEMBERS SIGNATURES. (Must have all signatures to be accepted).

1. ___________________________________ 7. __________________________________ 2.____________________________________8.__________________________________ 3.____________________________________9.__________________________________ 4.____________________________________10.__________________________________ 5.____________________________________11._________________________________ 6.____________________________________12._________________________________

Burkettsville Community Picnic 9th Annual CO-ED Mud Volleyball Tournament

July 28th, 2012 @ 10:00 a.m.

UP TO $400 FOR FIRST PLACE

PAYOUT IS BASED ON NUMBER OF TEAMS PARTICIPATING Top 3 positions guaranteed to win money
First 16 Teams to sign up and pay. Must have registration forms turned in to Doug Hemmelgarn to qualify. Email hemm1998@hotmail.com or call 419-375-1099 for additional sign-up sheets.

SIGN UP DEADLINE: SATURDAY JULY 23RD

COST: $120.00 per team before July 14th, $140 per team after July 14th Please make checks out to the Burkettsville Community Picnic Inc. PLEASE SEND AN EMAIL IF YOU ARE ENTERING A TEAM TO: hemm1998@hotmail.com
SEND ENTRIES TO: Doug Hemmelgarn P.O. Box 141 Burkettsville, Ohio 45310

Line-up Drawing Saturday, July 30th, 2011 at 9:30 a.m. Play Saturday July 30th, 2011 at 10:00 a.m. SHARP!!
Held at the Burkettsville Park. RULES
1. Eight men or women on the court at one time with at least two (2) of opposite gender on the court. Example: 6 men and 2 women, or 6 women and 2 men. 2. Must have waiver signed to play. 3. Rules of regular volleyball will be the same-including rotation of players. 4. In the event of an injury, the referee will stop the game, and a substitute can be made. 5. Head referee has the right to stop the game at their discretion. 6. THIS IS A DOUBLE ELIMINATION TOURNAMENT. 7. Best of three game matches. Each Game goes to 15 points. All scoring will be done by rally scoring. 8. Shoes must be worn (can be duct taped on) at all times. 9. The decisions of the referee are final. 10. 1 PERSON FROM EACH TEAM MUST BE A LINE JUDGE FOR THE GAME IMMEDIATELY FOLLOWING THE ONE THEY JUST PLAYED. 11. MUST BE ON TIME OR YOU WILL FORFEIT GAME.

We are offering T-Shirts for this years tournament at a cost of $12 each These are off white/natural color and made of a poly-cotton moisture wicking material. T-Shirts will be as shown below.

T-Shirt Order Form

Team Name: SIZE Small Medium Large X-Large XX-Large XXX-large QTY. PRICE EACH $12 $12 $12 $12 $12 $12 TOTAL PRICE

Total Shirts

Order Total

Please return with entry form if possible Make checks payable to: Doug Hemmelgarn Shirts will be handed out the day of the tournament