National 8-Ball Tournament
Hosted by P.O.E.M. Recreation Council
SATURDAY MAY 11, 2024
HUSTLER BILLIARDS INC.
1116 Dearness Drive, London, ON N6E 1N9
REGISTRATION FEE: $20.00 per PLAYER

Includes Prizes and Cash Prizes
• Registration starts at 10:45 – 11:30 a.m. and play begins at 12 p.m.
• Tournament hosted by P.O.E.M. Recreation Council and is open to all
Unifor members, retirees, spouses and families.
• Scotch Doubles Round Robin (Valley Rules Apply)
• All participants will be obligated to sign Release of Liability waiver of
Claim, Assumption of Risks and indemnity Agreement prior to the start of
the first game.
• PLEASE DRINK RESPONSIBLY
• Payment by Local Union cheque OR Money Order made out to Unifor

POEM Council and mail to:
Jean Simpson c/o POEM Council
20-1199 Reardon Blvd
London, ON N6M 1H7

*DEADLINE FOR ENTRIES – MONDAY, MAY 6, 2024*
For Further Information Contact Tournament Director:
Jean Simpson 519-494-3396

PLEASE PRINT
Name: Local: _______
Address: _____________________________________________________
City: Postal Code: Local: ___
Phone Number: E-Mail ___________________

PLEASE READ CAREFULLY – BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS INCLUDING THE RIGHT TO SUE OR CLAIM INDEMNITY IN RELATION TO THE ACTIVITY DESCRIBED HEREIN
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS, AND INDEMNITY

By signing this document, I declare that I am aware that my participation in the (POEM 8-Ball Tournament) to be held (May 11, 2024) (the “Activity”) to be held at Hustler Billiards Inc. London, ON) (the “Location”) involves risks and dangers to myself including, but not limited to, potential injury, death, personal property damage and economic loss resulting directly or indirectly from any of these (the “Risks”). I further declare that I understand that my participation in the Activity may result either directly or indirectly in injury, death, personal property damage and economic loss to a third party for which I would be responsible (the “Responsibilities”).

BY SIGNING THIS DOCUMENT, WITHOUT WHICH I CANNOT PARTICIPATE IN THE ACTIVITY, I personally accept and assume all Risks and Responsibilities and agree to the following:

1. I AGREE TO WAIVE ANY AND ALL CLAIMS that I have or may have in the future against Unifor and/or any Unifor Local and/or any Unifor Council, and/or their respective directors, officers, employees, trustees, representatives, and agents (collectively the “RELEASES”) in relation to the Risks and/or Responsibilities and/or my presence at or on my way to or from the Location;
2. I RELEASE THE RELEASEES from any and all liability for any and all claims that I or my next of kin may have against the Releases as a result of my participation in the Activity and/or my presence at or on my way to or from the Location;
3. I AGREE TO INDEMNIFY AND HOLD HARMLESS THE RELEASEES from any and all liability for claims that any third party may have against the Releases as a result of my participation in the Activity and/or my presence at or on my way to or from the Location;
4. I AGREE THAT THIS RELEASE SHALL BE EFFECTIVE EVEN IN THE EVENT THERE IS NEGLIGENCE, BREACH OF CONTRACT, OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER ONTARIO’S OCCUPIERS LIABILITY ACT OR SIMILAR LEGISLATION IN ANY PROVINCE, ON THE PART OF THE RELEASEES;
5. I AGREE THAT THIS RELEASE shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;
6. I AGREE THAT THIS RELEASE shall be governed by and interpreted in accordance with the laws of the province in which the Location is situated; and
7. I AGREE THAT ANY LITIGATION resulting from my participation in the Activity and/or my presence at or on my way to or from the Location shall be brought in the province in which the Location is situated.
By signing this document, I am not relying upon any oral or written representations or statements made by the Releases other than what is set forth in this release.
I have read and understood this document. I acknowledge that by signing this release I am waiving certain legal rights which I or my heirs, successors, executors or administrators etc. may have against the Releases.
PRINT NAME CLEARLY SIGNATURE DATE
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
*If the participant is under 18 years of age, the signature of a parent or guardian is required.

HOTEL ACCOMODATIONS: COURTYARD BY MARRIOTT – 864 Exeter Road Phone: 519-680-0070

DAYS INN BY WYNDHAM – 1100 Wellington Road Phone: 519-681-1240

FOUR POINTS BY SHERATON LONDON – 1150 Dearness Drive Phone: 519-681-0600

HOLIDAY INN & SUITES – 855 Wellington Road Phone: 519-668-7900

QUALITY SUITES LONDON – 1120 Dearness Drive Phone: 519-680-1024