Pickleball Registration Form Location: Hughes Park – 725 SW Orleans, Topeka, KsTournament Director: Mike ChicoContact Mike at 785-806-0203 for questions regarding the tournament.Entry Deadline: Wednesday June 5th, 2024NOTE: Registration required for each entrant into the tournament. Date: Saturday June 8th, 2024 Divisions: Men & Women's Doubles Start Time: 8:00 am Format: Double Elimination Levels: 3.0 Beginner, 3.5 Intermediate, 4.0 Advanced Date: Sunday June 9th, 2024 Divisions: Mixed Doubles Start Time: 8:00 am Format: Double Elimination Levels: 3.0 Beginner, 3.5 Intermediate, 4.0 Advanced $40 entry fee per participant. Covers cost of single entrant in EITHER Male or Female Doubles Tournament AND/OR entry into Mixed Doubles tournament. 1st, 2nd, and 3rd place medals for each level in each division. Medical Tent available onsite. Water and snacks provided in AM. Registration Form: Contact Information:Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone #:(Required)Cell Phone #:Email:(Required) Men's/Women's Divisions Men's Doubles Women's Doubles Mixed Division Mixed Doubles June 8th Men & Women's Doubles Men's Doubles DivisionMen's Doubles Skill Level 3.0 Beginner 3.5 Intermediate 4.0 Advanced Men's Doubles Entry 3.0 Beginner Price: Men's Doubles Entry 3.0 Beginner Partner Info:(Required)NamePhoneEmailDoubles partner information.Men's Doubles Entry 3.5 Intermediate Price: Men's Doubles Entry 3.5 Intermediate Partner Info:(Required)NamePhoneEmailDoubles partner information.Men's Doubles Entry 4.0 Advanced Price: Men's Doubles Entry 4.0 Advanced Partner Info:(Required)NamePhoneEmailDoubles partner information.Women's Doubles DivisionWomen's Doubles Skill Level 3.0 Beginner 3.5 Intermediate 4.0 Advanced Women's Doubles Entry 3.0 Beginner Price: Women's Doubles Entry 3.0 Beginner Partner Info:(Required)NamePhoneEmailDoubles partner information.Women's Doubles Entry 3.5 Intermediate Price: Women's Doubles Entry 3.5 Intermediate Partner Info:(Required)NamePhoneEmailDoubles partner information.Women's Doubles Entry 4.0 Advanced Price: Women's Doubles Entry 4.0 Advanced Partner Info:(Required)NamePhoneEmailDoubles partner information.June 9th Mixed DoublesMixed Doubles DivisionMixed Doubles Skill Level 3.0 Beginner 3.5 Intermediate 4.0 Advanced Mixed Doubles Entry 3.0 Beginner Price: Mixed Doubles Entry 3.0 Beginner Partner Info:(Required)NamePhoneEmailDoubles partner information.Mixed Doubles Entry 3.5 Intermediate Price: Mixed Doubles Entry 3.5 Intermediate Partner Info:(Required)NamePhoneEmailDoubles partner information.Mixed Doubles Entry 4.0 Advanced Price: Mixed Doubles Entry 4.0 Advanced Partner Info:(Required)NamePhoneEmailDoubles partner information.ATHLETIC WAIVER OF LIABLITY AND HOLD HARMLESS AGREEMENT(Required) I agree.ATHLETIC WAIVER OF LIABLITY AND HOLD HARMLESS AGREEMENT There are certain inherent risks associated with participating in sports and/or athletic training that cannot be eliminated. These risks include, but are certainly not limited to: (1) minor injuries such as scratches, cuts, bruises and strains; and (2) major injuries such as injuries to the eyes, infection, loss of sight, joint injuries, back injuries, heart attacks, concussions, paralysis and even death. Also included in these risks are the same or similar injuries that might result from using training equipment, actual use of a field or training facilities, the acts of others or from the unavailability of emergency staff or emergency medical care (hereinafter we shall define all of these risks and potential injuries as “Risks”). All of these Risks will be present in the activities that you and/or your minor will be participating in at the Our Lady of Guadalupe Church Fiesta Topeka Pickleball Tournament (the “Fiesta Topeka Pickleball Tournament” or “Activities”). HAVING READ THIS PARAGRAPH and having an appreciation for and an UNDERSTANDING OF THESE RISKS, you hereby affirm that you and/or your minor’s participation in these Activities is voluntary and that you agree on behalf of yourself or your minor to all of the following: 1. ASSUMPTION OF RISK I, on behalf of myself and/or my minor, ASSUME ALL OF THE RISKS THAT MAY OR CAN ARISE OUT OF PARTICIPATING IN THE ACTIVITIES, INCLUDING BUT NOT LIMITED TO THE ATHLETIC ACTIVITY ITSELF, USE OF THE EQUIPMENT, FIELD OR FACILITIES, THE ACTS OF OTHERS OR THE UNAVAILABLITY OF EMERGENCY CARE, as well as those Risks described in the preceding paragraph. 2. INDEMNITY/HOLD HARMLESS I, on behalf of myself and/or my minor and/or our heirs, personal representatives and/or assigns, also agree to indemnify and hold Fiesta Topeka Pickleball Tournament, as well as their affiliates, parents, subsidiaries, assigns, partners, attorneys, members, employees, independent contractors, shareholders, officers, directors, and agents or any producers, investors, cast members or any other person or entity associated in any way with the ownership, operation or affiliation with recreational facilities and the creation, production or distribution of Fiesta Topeka Pickleball Tournament-related marketing content on any Fiesta Topeka Pickleball Tournament-owned website, harmless from any and all claims, causes of actions, lawsuits, arbitrations or proceedings as well as from any expenses, judgments, costs, fees, damages, expenses and/or liabilities, including attorneys’ fees incurred in defending or prosecuting any such claims brought against Fiesta Topeka Pickleball Tournament as the result of my or my minor’s participation in the Activities. I hereby allow Fiesta Topeka Pickleball Tournament to use my or my minor’s image or likeness without current or future compensation for marketing purposes related to Fiesta Topeka Pickleball Tournament. 3. RELEASE/WAIVER In consideration for being permitted to participate in the Activities, I, on behalf of myself and/or my minor and/or our heirs, personal representatives and assigns HEREBY RELEASE, WAIVE AND DISCHARGE Fiesta Topeka Pickleball Tournament from any and all liability associated with or related to my or my minor’s participation in the Activities and agree NOT TO SUE Fiesta Topeka Pickleball Tournament for any reason resulting from or associated with my or my minor’s participation in the Activities. This waiver and release is intended to include all claims for injuries, accidents, illnesses, or property loss, whether known or unknown or anticipated or unanticipated, which are in any way related to or associated with the Activities. 4. NO INSURANCE I, on behalf of myself and/or my minor, acknowledge that Fiesta Topeka Pickleball Tournament does not carry insurance on behalf of myself or my minor. 5. LEGAL RIGHTS I, on behalf or myself and/or my minor, understand and acknowledge that I/we are surrendering valuable legal rights in this agreement. 6. SEVERABILITY I, on behalf or myself and/or my minor, understand and expressly agree that this agreement is intended to be as broad and inclusive as permitted by the law of the State for which it is used and that if any portion of this agreement is held invalid, it is agreed that the balance of the agreement shall continue in full force and effect and that whatever portion is held invalid shall be interpreted and construed to afford as much protection to Fiesta Topeka Pickleball Tournament as permitted by the applicable law. Participants Name(Required) First Last Date(Required) MM slash DD slash YYYY FOR PARTICIPANTS OF MINORITY AGE - (UNDER AGE 18 AT THE TIME OF REGISTRATION) CONSENT AND RELEASE ON BEHALF OF MINOR I agree.I am the parent and/or legal guardian of the above named minor participant. I have read this agreement thoroughly and understand all of the terms. I understand that I am surrendering legal rights on behalf of the minor and myself. I, on behalf of myself and my minor, agree to be bound by all of the terms of this agreement and also give my consent to allow my minor to participate in the Activities described herein. I release and agree to indemnify and hold harmless the Releasees from any kind and all liabilities incident to my minor child’s involvement or participation in these programs as provided above, even if arising from the negligence of the releases, to the fullest extent permitted by law. Parent/Guardian's Name(Required) First Last Date(Required) MM slash DD slash YYYY Relationship to Minor(Required) Entry Fee: Price: Total: Credit Card Cardholder Name Card Details ***Rainout date TBD***