Burkettsville Community Picnic 12th Annual

CO-ED Mud Volleyball Tournament

June 13th, 2015 @ 10:00 a.m. @ Burkettsville Park

Team Name: (please print)______________________________________________________

Captain______________________________________________________________________
Address______________________________________________________________________
Street

City

State

Zip

Phone Number________________________________________________________________
Captains Signature____________________________________________________________

***ABSOLUTLEY NO CARRY IN FOOD OR DRINKS***

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. _____________________________ 6. ________________________________
2.______________________________7.________________________________
3.______________________________8.________________________________
4.______________________________9.________________________________
5.______________________________10._______________________________

Burkettsville Community Picnic 12th Annual

CO-ED Mud Volleyball Tournament
June 13th, 2015 @ 10:00 a.m. @ Burkettsville Park

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: TUESDAY JUNE 9th

COST: $140.00 per team before May 30th $160 per team after May 30th
Please make checks out to: 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, June 13th, 2015 at 9:30 a.m.

Play Saturday June 13th, 2015 at 10:00 a.m. SHARP!!

***ABSOLUTLEY NO CARRY IN FOOD OR DRINKS***

RULES
1. Eight men or women on the court at one time with at least two 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 or the clock at their discretion.
6. THIS IS A DOUBLE ELIMINATION TOURNAMENT.
7. Best of three game matches. First 2 games go to 15 points. Third to 11 points.
All scoring will be done by rally scoring.
8. Shoes must be worn (and 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.