Brookings Area Senior Games Registration Form â—? July 20 & 21, 2018 Name: _______________________________________________________ Male ___Female ___ PLEASE PRINT
(LAST)
(FIRST)
(MI)
Address: __________________________________________ Home Phone: ____________________ City____________________ State__________ Zip__________ Cell Phone: ____________________ Email Address (print in all caps) ___________________________________________________________________________________________ Birth Date (mm/dd/yyyy): __________________ 50-54
55-59
60-64
Circle your age category (as of 12/31/2018)
65-69
70-74
Waiver and Hold Harmless Agreement I, the undersigned participant, hereby waive and release any and all claims or causes of action arising out of any injuries I may sustain as a result of my participation in the 2017 Brookings Area Senior Games, including those attributable to negligence and/or weather conditions. This waiver and agreement shall indemnify, and hold harmless the City of Brookings and its officers, officials, employees, agents and volunteers and the Brookings Area Senior Games leadership and volunteers, from and against all claims, damages, losses and expenses, including but not limited to, attorneys’ fees, arising out of or resulting from my participation in the Brookings Area Senior Games and shall be binding upon me and my heirs, personal representatives and assigns. Publication Release In participating in the Brookings Area Senior Games, I am specifically granting permission to you to use the likeness, voice and words of myself in television, radio, films, newspapers, magazines and other media and in any form not heretofore described, with the intent of communication the purpose and activities of the Brookings Area Senior Games without my remuneration. I certify that I have read and agree to the above entry information. SIGN HERE
SIGNATURE
DATE
75-79
80-84
85 +
PLEASE COMPLETE BOTH SIDES OF ENTRY FORM! Advance registration deadline is Friday, July 13th. Advance registration is strongly encouraged but not required (except for 8-ball pool). Registration packets including a map of locations can be picked up at the Brookings Activity Center, 320 5th Avenue from noon to 4 on Friday and at the event sites on Saturday. For additional information, call the Brookings Activity Center at 605-692-4492 or the Brookings Park and Recreation Office at 605-692-2708. You may also e-mail us at tsaugstad@cityofbrookings.org.
Brookings Area Senior Games Registration Form ● July 20 & 21, 2018 Friday, July 20th _____ 12:30 8-ball Pool (Skinners Pub) (PRE-REGISTRATION REQUIRED – LIMIT 16)
6:00 Basketball Shoot (5th Street Gym) _____ Free Throws _____ Field Goals
_____ 3:30 Bean Bag Toss (BAC) 6:00 Table Tennis _____ Singles _____ Doubles
_____ 3:30 Shuffleboard (BAC)
(5th Street Gym)
Saturday, July 21st ALL TRACK AND FIELD EVENTS WILL BE AT THE BROOKINGS HIGH SCHOOL Time 9:30 am
Event
Time 9:00 am
Event
_____ 800 Meter Race Walk
_____ Discus
_____ 800 Meter Run
_____ Shot Put
_____ 1500 Meter Run
_____ Standing Long Jump
_____ 1,500 Meter Race Walk
_____ Running Long Jump
_____ 100 Meter Dash
_____ Softball Throw
_____ 50 Meter Dash
_____ Javelin
_____ 400 Meter Dash _____ 400 Meter Race Walk _____ 200 Meter Dash _____ 1:30 Pickleball
(5th Street Gym)
_____ Singles _____ Doubles
_____ 1:30 Jump Rope (5th Street Gym) _____ 1:30 Horseshoes
(Hillcrest Park)
Cost is $2.00 per event, up to a maximum of $10.00. Starting times are approximate so please check in for events 30 minutes prior to start time. Some events may be men and women combined depending on the number of entries. Please indicate the events you wish to participate in and return this form along with your payment to: Brookings Activity Center Attn: Brookings Senior Games 320 5th Ave Brookings, SD 57006
PLEASE COMPLETE BOTH SIDES OF ENTRY FORM!