Thanksgiving Dodgeball Tournament

When:Wednesday, November 25th

Where: Ageless in Gillespie-103 N. Jersey Street

Time: Your team captain will be contacted with your start time-earliest time is4:00 p.m.

Estimated Schedule:

  • 4:00 p.m. 1st grade
  • 5:00 p.m. 2nd and 3rd grade
  • 6:00 p.m. 4th and 5th grade
  • 7:00 p.m. 6th-8th grade

YOUR CAPTAIN WILL BE CONTACTED WITH YOUR START TIME. The TIME DEPENDS ON NUMBER OF TEAMS PER AGE GROUP!

Cost: $25 per team-$5 per person-Teams of 5

Ages: 1st-8th grade-divisions will be divided by grades; If there are players from different grades, your team will be in the bracket with the oldest member of your team.

Deadline to enter is November 24th by noon

Misc:

  • Teams consist of 5 players with a minimum of 4.
  • Money and team members’ names must be turned in before the team will be added to the tournament.
  • Team captains will be contacted on Nov. 24th with their time of their first match.

Dodge Ball Tourney

Wednesday, Nov. 25th

Forms due Nov. 24th

Money($25.00) must be turned in with the form.

Team Name: ______

Team members’ names:

1. ______Grade: ______

(Captain-he/she will be contacted with the bracket information)

2. ______Grade: ______

3. ______Grade: ______

4. ______Grade: ______

5. ______Grade: ______

Contact information: Captain

Name: ______

Phone number: ______

E-mail: ______

Any questions, please call Corrie at217-313-6465 or Ageless at 217-839-2484.

WAIVER & RELEASE FORM

As the parent or legal guardian of ______(print name of child), I hereby give permission for my child to participate in activities at Ageless, LLC. I understand that the program has activities that can involve physical contact with other participants, the ground or equipment, and that there is a resulting risk of physical injury to my child.

I have explained these risks and benefits of participating in this program to my child and my child is in proper physical condition and has no existing injuries or conditions that could jeopardize his/her safety or health, or the safety or health of the other participants.

I therefore release and discharge all liability for any harm or injury suffered directly or indirectly as a result of my child's participation in any activities at Ageless LLC, including but not limited to the Ll’ Muscles Exercise Program, whether or not resulting from negligence, and I agree not to sue Ageless, LLC, its representatives, staff, or volunteers on any such claim. I also give permission for the staff, representative, or volunteers of Ageless, LLC to administer first aid or to seek medical care for my child during my child's participation in the program, including transportation of my child to a medical facility for additional treatment that appears necessary.

Print name of Parent/Guardian: ______

Signature of Parent/Guardian: ______

Date: ______