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Registration Information & Forms

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Print off your registration forms, as well as find out more information about sign in dates and time.

Print off your registration forms, as well as find out more information about sign in dates and time.

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  • 1. Virginia Senior Games 2010 Welcome to the 32nd Annual Virginia Senior Games Our philosophy is to provide something for EVERYONE 50 & Better! From swimming and tennis to canasta, events are chosen to include the non-athletic as well as the athletic, to accommodate all skill levels, and to promote an atmosphere of competition and FUN! Age Requirement: The minimum age to compete is 50 years old. Age divisions for all individual competition will be determined by the athlete’s Check In Dates, Times & Locations: age on December 31, 2010. Age divisions for all doubles, Registration check in dates and times: mixed doubles and team competition will be determined by Wed. May 5 2 - 5pm Belmont Rec. Center the age of the youngest team member on December 31, 2010. Thurs. May 6 7am - 3pm Belmont Rec. Center Game officials reserve the right to combine age groups of Fri. May 7 7am - 3pm Belmont Rec. Center Sat. May 8 7am - 12noon Hermitage High School any event due to insufficient entries. Events are divided into Sun. May 9 6 - 9am West Creek separate divisions for men and women. Age categories will Check in location addresses listed on page 4. be in 5-year increments, unless otherwise specified. Be sure to go to Check In (times and locations How to Register: (Register by: April 16, 2010) listed above) to receive your packet of information Individual Entry Form including your Virginia Senior Games 2010 T-Shirt, Athletes: Complete the enclosed registration participant bag, name tag, and ticket for social (for forms: those who have registered for the social). •Individual Entry Form, sign and date Waiver & Release of Liability Event Entry Form at bottom of page Refund Policy: Requests for refunds must be received in writing by 5pm •Event Entry Form on April 16, 2010. Cancellations are subject to a 20% administrative fee. No refunds will be considered after April Team Entry Form Teams: 16, 2010. There will be no refunds if an athlete or team fails to •Team Rosters must be participate, or if inclement weather forces event cancellation. Every effort will be made to reschedule events cancelled due submitted by Team Captains to inclement weather. on Team Entry Form • Team Entry: All team members must complete Questions? the Individual Entry Form, sign and date the Please direct any questions regarding your registration, Waiver & Release of Liability Form event rules and VSG requirements to the Virginia Recreation at bottom of page and Park Society between 9am & 5pm M-F. Phone: (804) 730-9447 email: vsg@vrps.com FAX your registration: 804-730-9455 www.VirginiaSeniorGames.org Also, look for us on MAIL your completed forms with your check or money order, made payable to Virginia Senior Games to: Virginia Senior Games - VRPS Table of Contents 6372 Mechanicsville Turnpike, Suite 109 Gold Medal Sponsor . . . . . . . . . . . . . . . . . . . . . . . . . .2 Mechanicsville, VA 23111 Registration Check-in Times . . . . . . . . . . . . . . . . . . . .3 General & Hotel Information . . . . . . . . . . . . . . . . . . .4 Registration Deadline - Friday April 16, 2010 Venues at a Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . .4 • Forms postmarked on or before April 16 will Athletic Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6 meet the entry deadline. Individual Entry Form . . . . . . . . . . . . . . . . . . . . . . . . .7 • Forms postmarked April 17 or later will be Waiver and Release of Liability Form . . . . . . . . . . . . . .7 considered a late entry. Late entries will be accepted Event Entry Form . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 on a space available basis and will be assessed a LATE Team Entry Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 ENTRY FEE of $15 (in addition to the event fee). Volunteer Form . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10 Absolutely NO registrations accepted after Virginia Senior Games Sponsors . . . . . . . . . . . . . . . . .11 April 23 and NO on-site registrations allowed. 3
  • 2. Individual Entry Form - Please Print Gender: Male: _____ Entrant:___________________________________________________________________ Female: ______ (First) (Middle) (Last) Address:______________________________________________________Date of Birth:____/_____/19____ Age: _____ City:__________________________________________________________ *State:______________ Zip:___________ Email: _________________________________________________________ Phone: ____________________________ *Confirmations will be e-mailed. Hometown Newspaper: _____________________________________________________ * Non-Virginia residents must pay a $15 out-of-state fee in addition to the event fees. T-shirt: (circle one) S M L XL (XXL $2 extra & XXXL $4 extra) (NO t-shirt for late entrants!) Emergency Contact Name: _______________________________________ Phone: ____________________________ AN UPTOWN HOEDOWN: Friday, May 7, Belmont Recreation Center, 6:30 pm (Dinner served at 7pm) Please add $18 per person to your registration check for each person attending in your party. Number in your party?______ Square Dancing Demonstration for Clubs: Saturday May 8, 11am at Hermitage High School. ____ Yes, I will be participating. Club name in Demonstration: _______________________________________________ The staff and volunteers of the Virginia Senior Games are committed to creating a healthy and safe environment for all participants, staff and spectators. We request that every participant consult their doctor regarding preparation for and participation in the Senior Games. Special Accomodations Needed: ___________________________________________________________________ _____________________________________________________________________________________________ WAIVER AND RELEASE OF LIABILITY (All Registrants must sign this form to participate.) In consideration of the acceptance of my application for registration in the Virginia Senior Games, I hereby waive and release for myself, my heirs, executors, and administrators any and all rights and claims for injuries, damages, and/or losses to include loss of life, (except for personal injury solely and proximately caused by the negligence of The Virginia Recreation and Park Society, any sponsor, and/or their respective officers, employees, or agents, their representatives, and their affliliates) arising out of any and all activities connected with the Virginia Senior Games. I acknowledge and understand the inherent risks involved with participating in the physical activities of the Virginia Senior Games. By signing this waiver and release, I affirmatively declare and warrant that: l I am physically healthy and able to participate, l I have no medical condition that may limit or impair my safe participation in the games, l I have received my doctor’s permission, if necessary, to participate, and l I voluntarily assume all foreseeable risks associated with physical activity incident to the Virginia Senior Games. I understand that photographs or videos of me may be taken during the events, that my likeness may appear in news coverage, publications, and/or other publicity regarding the Virginia Senior Games, that no compensation will be made by the sponsors, and I give my consent to these conditions. Signature:________________________________________________Date:_________________________________ * Non-Virginia residents must pay a $15 out-of-state fee in addition to the event fees. 9
  • 3. Event Entry Form - Please Print • Check only events you are entering. Note that you may enter as many events as you choose, however if there is an overlap in the schedule, you must be at the event at starting time or risk being disqualified. • Registrations must be postmarked no later than April 16, 2010. Entries postmarked after this date will be accepted on a space available basis and must include a $15 late registration fee. Absolutely NO registrations accepted after April 23, 2010. NO on-site registration allowed. • There will be no refunds for missed events or events cancelled due to inclement weather. • Non-Virginia residents must pay a $15 out–of–state fee in addition to the event fees. Archery ($18 per event, $38 max) Shuffleboard ($18 per athlete per event) Swimming ($11 per event, $40 max) Compound Finger Singles United States Master Swimming Recognized Compound Release Doubles and/or Mixed Meet. If no entry times are submitted, Recurve _________________________________ partcipants will be seeded randomly. Barebow Recurve Partner’s Name Barebow Compound Finger Entry Time Softball 400mtr freestyle Badminton ($18 per event, $38 max) Softball Hit & Throw ($17 per athlete) 100mtr Breaststroke Singles Softball Tournament 50mtr Butterfly Doubles ________________________ May 14-16 Glen Allen Sport Complex 200mtr Backstroke Partner’s Name (SPA Dogwood Classic Tournament) 100mtr Butterfly Mixed ________________________ For more details contact Scott Southworth at Partner’s Name 50mtr Freestyle (804) 355-3837. See page 5. Basketball 200mtr IM Basketball Free Throw ($17 per event) Square Dancing ($15 per athlete) 200mtr Freestyle Basketball 3 on 3 ($85 per team) Last Square Standing 100mtr Backstroke _________________________________ Competition: ____________________ (Team Name-use team entry form) Partner’s Name 50mtr Breaststroke Square & Club Name: ________________ 100mtr IM Billiards (if available) Skill Level: 200mtr Breastroke Billiards ($17 per athlete) ____________________ (Mainstream, Plus, Advanced) 100mtr Freestyle Bowling ($20 per event, $45 max) Table Tennis ($18 per event, $38 Max) 50mtr Backstroke Singles Singles Doubles _________________________ Doubles ________________________ SOCIAL: An Uptown Hoedown Partner’s Name Partner’s Name FRIDAY, May 7, 6:30 pm *Dinner served at 7pm Mixed ___________________________ $18 per person (Please add $18 per person Partner’s Name Mixed __________________________ Partner’s Name to your registration check for each person Canasta attending in your party.) Canasta ($12 per athlete) Tennis ($18 per event, $38 max) _________________________________ Singles Total Event Fees: $______ Partner’s Name Doubles ________________________ Administrative Fee $ 4.00 Cycling ($25 per event, $40 max) Partner’s Name (admin fee is for all athletes) Cycling 5K Mixed __________________________ Partner’s Name Social Fees: ($18 per person) $______ Cycling 20K Out of State Fee: ($15) $______ Golf Tournament ($45 per athlete) Track & Field ($11 per event, $40 max) (if applicable) Handicap ______________ Race Walk 5K (8 am) Late Fee: ($15) $______ Horseshoes ($18 per athlete) Race Walk 1500 meter (12:30 pm) (For entries postmarked after 4/16/10 - Registrations must be received by 4/23/10) Horseshoes 50m Run (9:30 am) 100m Run (11:00 am) Become a Friend of the Virginia Senior Mini Golf ($17 per athlete) 200m Run (2:30 pm) Games with a tax deductible contribution. Mini Golf 400m Run (12:00 pm) $______ 800m Run (1:30 pm) Thank you! Pickleball ($18 per event, $38 max) 1500m Run (10:30 am) Singles Long Jump (8:30 am) TOTAL PAYMENT ENCLOSED: $______ Doubles _________________________ High Jump (w-11:30 am, m-1:00 pm) Partner’s Name Mixed _________________________ Shot Put (w-12:00 pm, m-1:30 pm) Partner’s Name Discus (w-10:00 am, m-11:30 am) (For Office Use Only) Pole Vault (1:30 pm) Event Total________________________ Racquetball ($18 per event, $38 max) Amount of Money Submitted __________ Javelin (m-9:30 am, w-1:00 pm) Singles Late Fees _________________________ Doubles _________________________ Volleyball ($85 per team, use team entry form) Difference _________________________ Partner’s Name Mixed _________________________ Volleyball Men - Team: ________ Partner’s Name Volleyball Women - Team: ________ Volleyball Co-ed - Team: _______ Registration Deadline: Road Race ($18 per athlete per event) April 16, 2010 Road Race 5K 10 Road Race 10K
  • 4. Team Entry Form - Please Print • The team captain must complete and submit this team roster along with the individual entry form with signed Waiver and Release of Liability and administrative fee ($4) from each participant (if athletes are participating in more than one event only one administrative fee is assessed). All players must be 50 on or before December 31, 2010. Teams are required to compete in the age category of the youngest player. • Roster must include entire team and all non-playing team members. Remember that a maximum of three players may be added to a roster following qualification for the National Senior Games and those individuals must have been registered in a qualifying state game in that sport to be eligible for additions. Number of players allowed: Basketball - 10; Volleyball - 15; Softball - 20. If you have any questions concerning this, please call Andy Crane at (804) 501-5156 or Keith Rotzoll (804) 733-2646 • Your official playing roster will be determined by the completed Team Entry Forms received by the VRPS office by the Registration Deadline Sportsmanship Statement: Behavior that contributes to the creation of a threatening, dangerous or harassing atmosphere for participants, spectators, game officials or event staff will not be tolerated. If such behavior occurs, the person shall be ejected from current game/event and serve a minimum of one game/event suspension. Men Captain will pick-up team packets T-shirt: S M L XL (circle one) Women (XXL $2 extra & XXXL $4 extra) Co-ed No t-shirt for late entrants Team Name:____________________________ Sport: ___________________ Age Division: ________ Team Contact:______________________ Phone: (day)___________________(night) ______________ Address: ___________________________________________________________________________ City/State: ________________________________ Zip: ______ Email: _________________________ *Confirmations will be e-mailed. (Each team member must complete the Individual Entry Form and sign the Waiver on page 7.) Non- Name Birthdate T-shirt size Player Player 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 11 Virginia Senior Games 2010 - Where Athletes are Forever Young

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