SCNOVA Pickleball Mixer & Fundraiser 2023 Registration for October 19th Fun & Fundraising Event First NameLast NameAddressCity/State/ZipEmail AddressMobile PhonePlease check one I will be attending the event and playing pickleball. I will be attending the event and NOT be playing pickleball. I cannot attend the event but would like to make a donation. If playing pickleball, what is your skill level? Please check one. Never Played Pickleball Have Played Pickleball – Beginner Have Played Pickleball – Intermediate or Better Do you work for an older adult community, home health care service or an older adult focused business? Yes No If yes, please indicate which organization/company you work with.Will you be bringing your own pickleball paddle? Yes No Agreement, Release and Waiver of LiabilityI recognize and understand that there are certain inherent risks to which I will be exposed because of the nature and level of the sports activity in which I have agreed to participate. I understand and agree that the Shepherd’s Center of Northern Virginia (SCNOVA), Worldgate Athletic Club & Spa, their agents and officials assume no responsibility for injury or illness I may sustain as a result of my physical condition or my participation in any SCNOVA events. I understand it is my responsibility to provide my own accident and health coverage and that SCNOVA and Worldgate Athletic Club & Spa do not provide any accident or health insurance for their participants or volunteers. I also give permission to SCNOVA to use or distribute, without limitation or obligation, any record of the events which may include my voice or image. As evidenced by my signature, I hereby, for my heirs, administrators and assigns, release, waive and hold harmless SCNOVA, their agents and officials from any manner of claims or law suites that may result from my participation in the sports.SignaturePlease type your name herePhoneThis field is for validation purposes and should be left unchanged. Δ
