Bob Stevens Memorial Tennis Tournament: August 2 -4

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At the Van wert county Foundation tennis facility: 10708 St. Rt. 118, Van Wert Oh 45891

*All Proceeds Go To The American Cancer Society*

The Bob Stevens Memorial Tennis Tournament will take place from August 2nd-4th at the Van Wert County Tennis Complex. The cost is $25.00 for the first event ($15.00 for high school and college players) plus $5.00 for each additional event. Prizes will be awarded for 1st and 2nd place in each division. All participants will receive a t-shirt with their entry.
Please cut and mail _______________________________________________________________________________ Please Send Entry Form to: Chuck Rollins 9680 US Rt. 224 Van Wert OH. 45891 Name: _______________________ Shirt Size: ____________ Address: _______________________ City:_______ State:____ Zip:____________________ Phone:_________________ Texting: Yes___ No___ E-Mail: _______________________ Make Checks Payable to: The Van Wert County Tennis Association
Registration Deadline- July 29 Any Questions please call Chuck Rollins @ 419-203-0266
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Please check the appropriate boxes of the events that you wish to participate in. Divisions will be offered based on the number of entries received. If there are not enough entries for a draw, some events may need to be combined into one draw.

Mens Divisions: Open Singles___ Open Doubles___ (partner-________________) Senior Singles___ Senior Doubles___ (partner-_______________) Womens Divisions: Open Singles___ Open Doubles___ (partner-________________) Senior Singles___ Senior Doubles___ (partner-_______________) Mixed Doubles:___ (partner-_________________) Juniors Divisions: Boys Singles:___ Boys Doubles___ (partner-________________) Girls Singles:___ Girls Doubles___ (partner-________________) Junior Divisions = 18 and Under (Birthday as ofAugust 2nd ) Senior Divisions = 50 and Over (Birthday as of August 2nd ) Be sure to sign the waiver form on the back!!!!!! There will be a fun doubles event on Saturday Night from 6:00pm-8:00pm for the casual tennis player at a cost of $10 per person. The format will be rise and fall doubles with a winner determined at the end of play.

The tennis courts are located behind the High School/Middle School Complex at 10708 State Route 118, Van Wert, OH. 45891.

PARTICIPANT RELEASE OF LIABILITY Organization Name: Participant Name (Print): Van Wert City Schools and The Van Wert County Tennis Association 10708 State Route 118, Van Wert, OH. 45891 _________________________________________________

In consideration of being allowed to participate in any way in the program, related events and activities, and use of equipment, I the undersigned, acknowledge, appreciate, and agree that: 1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death. 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation. 3. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Van Wert City Schools and The Van Wert County Tennis Association, its officers, officials, agents and/or employees, other participants, sponsors, advertisers, and, if applicable, owners and lessors of premises used to conduct the event (RELEASEES), from any and all claims, demands, losses, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. X _____ Date:

FOR PARENTS/GUARDIANS OF PARTICIPANT OF MINOR AGE (UNDER AGE 18 AT TIME OF REGISTRATION) This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liability incidents to my minor childs involvement or participation in these programs as provided above, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, to the fullest extent permitted by law. X Parent/Guardian Signature Date:_____________________________________