Inaugural Hillsborough County

www.hillsboroughcounty.org/parks Northdale Owls Holiday Pickleball Classic Thursday, January 15th – Saturday, January 17th 15550 Spring Pine Drive- Tampa, Fl. 33624 Registration Form * All players must complete this form separately (one form per player) Name:______Age:______USAPA #______(Must be 50 yrs old and above) Address:______City:______State:______Zip Code:______Phone: (hm)______(Cell)______Email address (optional):______Skill Level: 2.5 and/or 3.0 3.5 4.0 4.5-5.0 Ages: 19+, 35+, 50+, 60+, 70+ Division: (please circle one): Men’s Dbl’s Women’s Dbl’s Mixed Dbl’s Shirt Size (please circle one):Adult sizes: Small Medium Large X-Large XXL Name of Partner: Doubles______

Mixed Dbl’s______I am attending the Dance Party on Thursday, January 15th from 6:00pm-8:30pm Payment Amount: $35/player (Includes Dance Party, T-Shirt, and Awards) Make out/mail to: Northdale Owls Pickleball Club 3853 Northdale Blvd #374 Tampa, Fl. 33624 DEADLINE TO REGISTER: Friday, January 9th, 2015

Call Coach Russell at 813-264-8541 for more Information or email at [email protected]

Waiver and Release of Liability

I certify that I am physically fit and have sufficient abilities for this program. I consent to allow my picture, or likeness, to appear in any official documentary, sponsor advertisement or exclusive media coverage in any manner incidental to his/her participation in the adult pickleball program, and without compensation to me. I agree to assume all responsibility for all risk, damage, or injury that may occur to me as a participant. I release and discharge, for myself, my heirs, executors, and administrators, Hillsborough County, their respective administrators, directors, agents, officials, and other sponsoring agencies (Northdale Owls) and advertisers used to conduct the event from any and all liability, present and future, which may arise in conjunction with my participation in this program.

Player Signature:______Date:______