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Captain____________________________________________________
Address____________________________________________________
Street City State Zip
Phone Numbers______________________________________________
Captains Signature___________________________________________
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.
1. _____________________________ 6. ________________________________
2.______________________________7.________________________________
3.______________________________8.________________________________
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5.______________________________10._______________________________
Burkettsville Community Picnic 7th Annual
CO-ED Mud Volleyball Tournament
July 24th, 2010 @ 10:00 a.m.
FIRST PLACE---$400.00
SECOND PLACE--$250.00
THIRD PLACE---$150.00
FORTH PLACE---$100.00
WHO: First 16 Teams to sign up and pay. Must have registration forms turned in to
Doug Hemmelgarn to qualify. Email hemm1998@hotmail.com for additional sign-up
sheets.
COST: $120.00 per team before July 10th, $140 per team after July 10th
Please make checks out to the Burkettsville Community Picnic Inc.
SEND TO:
Burkettsville Community Picnic
P.O. Box 204
Burkettsville, Ohio 45310
419-375-1099
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. 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 team will be disqualified for game missed.