Dysart Pickleball Tournament Registration Form

WHEN: July 3rd, 4th, 5th of 2026

WHERE: Callahan Courts, Dysart City Park

COST: $20 per team (Venmo @Janis-Wauters or send check to Janis Wauters, Box 83, Dysart, IA 52224) Payment must be received before the deadline.

TIMES/DIVISIONS:

July 3rd: 2 courts

**Adult singles (18+) 6:30 p.m. (6 teams max, any combination)

July 4th: 4 courts

**Adults (18-59) women, men, mixed 12:00 p.m.

(5 teams max for each division)

**Teens (13-17) 12 p.m. (5 teams max, any combination)

July 5th: 4 courts

**Youth (8-12) 11:00 a.m. (5 teams max, any combination)

**Seniors (60+) 11:00 a.m. women, mixed

(6 teams max for each division)

TOURNAMENT PLAY:

**All play is round robin; must keep same partner

**All levels of play; official pickleball rules apply; final decisions by

tournament facilitators; schedules subject to change based on

team numbers signed up on date of deadline, Saturday, July 20th.

PRIZES: TBD based on number of teams registered

***MUST REGISTER BY SATURDAY, JUNE 20TH***

Divisions

Athletes first and last names--MUST keep same partner throughout the tournament.

Player 1Player 2

Age as of July 1, 2026 for player 1 / player 2

Player 1 __________; Player 2 __________

Addresses for players

Street, city and state of Player 1

Street, city and state of Player 2

Email for Player1Email for Player 2

Cell phone numbers of Player 1 and Player 2

Parent/Guardian information if child is under 18 years of age.

Name

First NameLast Name

Home number

Format: (000) 000-0000.

Cell number

Format: (000) 000-0000.

Email

example@example.com

Emergency Information

Emergency contact's name

Player 1Player 2

Relationship

Phone number for player 1's emergency contact

Format: (000) 000-0000.

Phone number for player 2's emergency contact

Format: (000) 000-0000.

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.

Is the athlete prescribed an inhaler/glucose monitor? If yes, please explain any instructions.

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by the Dysart Pickleball Organization during the selected tournament. In exchange for the acceptance of said child’s candidacy by Dysart Pickleball Organization, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless, Dysart Pickleball Organization and all its respective officers, agents, tournament facilitators, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected tournament play.

In case of injury to said child, I hereby waive all claims against Dysart Pickleball Organization, including all coaches and affiliates, all participants, sponsoring agencies, advertisers, tournament facilitators and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including pickleball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Dysart Pickleball Organization and its affiliates including tournament facilitators, coaches, and team parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered event.

This release is authorized and executed of my own free will with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Date

I agree to the above

First NameLast Name

3rd Annual Dysart Pickleball Tournament Registration

Team Information