Corn Hole Tournament Registration Form
Ss Gregory and Barnabas Parish, Cover Hill Volunteer Fire Co and
America’s 911 Foundation
When: Saturday July 12th
Time: Registration and Pre-Registration Sign In Starts at 11 am
1st round begins at 12 (noon) and 1pm – (Please indicate below if you need a 1 pm start time)
Where: St Gregory’s Picnic Grounds 120 Boltz St Johnstown, PA 15902
Cost: Early Bird Registration $25.00/2-person team by June 22nd, $30.00/2-person team after June 22nd (Registration will
be accepted that day if spaces are available)
Event T-shirt included for each team member with cost of registration, proceeds benefit America’s 911 Foundation,
Ss Gregory & Barnabas Parish and Cover Hill Vol Fire Co
Food and Drink will be available for purchase, variety of small games of chance will be played, entertainment –music,
themed basket raffle, Bingo
Tournament will be a Double Elimination with awards going to 1st thru 4th place
2 age divisions: Adult: 18yrs and older
Children’ s area for 11 and under – no cost
Youth: 12yrs thru 17yrs
Minimal team registration must be 20 for adult class in order to hold the event and in order to hold the youth division 10
teams
Spectators Welcome!
Send Registration and payment to: Teresa Toth, Ss Gregory and Barnabas Parish, 120 Boltz St, Johnstown, PA 15902 –
Contact: Teresa Toth 814-241-7537 with any questions.
Team Member#1 Name _________________________ Contact Phone #______________________
Age_________ T-Shirt Size: please circle (Youth): Large
2X-Large 3X-Large 4X-Large
(Adult): Small
Medium Large
X-Large
Team Member#2 Name _________________________ Contact Phone #______________________
Age_________ T-Shirt Size: please circle (Youth): Large
2X-Large 3X-Large 4X-Large
(Adult): Small
Medium Large
X-Large
Name of Team _______________________________Require 1pm Start Time (please circle): Y / N
If under 18, name and contact number of parent/guardian
Team Member #1_____________________________ Team Member #2____________________________
Method of payment: Cash Money Order Check
Make all Money Orders and Checks payable to: Americas 911 Foundation
America’s 911 Foundation, Inc.
13630 Barnhouse Place, Leesburg, VA 20176
(877) 771-0118, Fax (703) 771-3959
www.americas911foundation.org
Federal Tax ID 42-1573312