2018 Indiana State Games Official Registration Form

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1 Participant Information 2018 Indiana State Games Official Registration Form First Name Last Name MI Preferred Name / / Age As of Dec 31st, 2018 Gender Male Female Address If you do not have , we will create one for you in Gmail. Mailing Address Address City State Zip County Home Phone # ( ) Cell Phone # ( ) Emergency Contact Name Relationship Phone # ( ) T-Shirt Size S M L XL XXL I am a NEW participant Yes No Did you recommend a friend to the games? Yes No Name of friend: If friend Registers, enter for $50 cash Ethnicity (Optional) African American Asian Hispanic Native American White Other Registration Fees All fees are non-refundable. Some events have additional fees. Athlete Fee Unlimited Event Athlete Fee & Dinner $35.00 $ Sport Add on Fees - Track & Field Add $5.00 Swimming Add $5.00 $5.00 Late fee if not post-marked by May 7th (May events only) Late Fee $5.00 Celebration of Athletes Reception Friday, May 18th 5:30 pm Attending YES NO Location: Tropicana Hotel Evansville the Walnut Room Please make plans to attend! FREE to Unlimited Event Athletes FREE to all $35 registered athletes. $15 fee for each additional guest Athlete Dinner $ Included Guest Dinner $ Guest $15.00 Additional Commemorative T-Shirt and Size add $10 - T-Shirt Size $ T-Shirt $10.00 Donation We appreciate any donation towards the future of the Indiana State Games Fit and 50! Thank You!! Donation Amount $ (tax-deductible contribution) TOTAL AMOUNT $ Payment Information Checks Payable to: Indiana State Games, Inc. Mail to: Indiana State Games Attn: Holly Schneider P.O. Box 6334 Evansville, IN Credit Card # Exp. Date CSV Name as it appears on Credit Card Signature WEB We cannot process registration unless the waiver is signed and fees are included. Must be received by May 7th deadline. We cannot process registration unless ALL team members (if applicable) have submitted their entry form and payments.

2 Sports Selection Thursday, May 17th Shuffleboard 9:00 am 1:00 pm Doubles Open Doubles Partner: / / Non Ambulatory Shuffleboard 9:00 am 1:00 Doubles Open Doubles Partner: / / Tennis 9:00 am 5K Road Race Power Walk 5K Friday, May 18th Racquetball 9:00 am Partner Doubles 1:00 pm Partner: / / Mixed Doubles Partner: / / Tennis Doubles & Mixed Doubles Partner Doubles 9:00 am Partner: / / Mixed Doubles Partner: / / Saturday, May 19th 5K Run 6:00 pm Location Garvin Park Horseshoes 1:00 pm This is a competitive event Non Ambulatory 1:00 pm This is a competitive event Horseshoes Celebration of Athletes 5:30 pm Tropicana Hotel Race Walk 1500 M 8:00 am Harrison High School Power Walking 1500 M 8:30 am Harrison High School Track & Field 9:00 am Running Events 1:00 pm Field Events Harrison High School 50M Run 100M Run 200M Run 400M Run 800M Run 1500M Run 5000M Race Walk Power Walking 5K 6:00 pm Location Garvin Long Jump Triple Jump High Jump Shot Put Discus Javelin Pole Vault Athletes responsible for field event equipment. Basketball 3 on 3 Team captains must fill out team roster 3 on 3 Team Basketball 10:00 am 70+, 75+, 80+, on 3 Team Basketball 1:00 pm 50+, 55+, 60+, 65+ Place me on a team- we cannot guarantee team placement Spot Shoot Recreational 12:00 pm All players must pay individual registration fee and sign waiver release form and be listed on team roster. All persons listed on team roster must pay individual registration fee and sign waiver release form. No exceptions. Sunday, May 20th Cycling 5KTT 9:00 am 10K 10:30 am 20K Road Race12:00 pm Disc Golf 18 Hole Disc Golf 1:00 pm Swimming 2:00 pm Pool opens at one 200M Ind. Medley 200M Butterfly 100M Freestyle 50M Freestyle 50M Butterfly 50M Backstroke 200M Backstroke 100M Breaststroke 50M Breaststroke 500M Freestyle Listed in order of events left column top to bottom, then right column. Monday, May 21st Bowling 9:00 am *Site Fee $8.00 Badminton 9:00 am Partner Mixed Table Tennis 1:00 pm Partner Mixed Swimming 10:00 am Pool opens at nine 100M Ind. Medley 200M Breaststroke 100M Backstroke 100M Butterfly 200M Freestyle 400M Ind. Medley Listed in order of events left column top to bottom, then right column. Tuesday, May 22nd Bowling Doubles 9:00 am Mixed Doubles 1:00 pm *Site Fee $8.00 Mixed Pickleball 9:00 am Doubles 1:00 pm Wednesday, May 23rd Pickleball 9:00 am Mixed Doubles Partner Mixed Doubles Partner: / / Putt Putt Golf Putt Putt 2:00 pm Thursday, May 24th Recreation Day 9:00 am Picnic Lunch at 12:00 2 Mile Walk Softball Throw Washers Horseshoes Recreational Corn Hole Name of Partner: Lunch FREE to registered athlete $5 per guest

3 Sports Selection continued Monday, June 4, 2018 Noblesville, IN Golf 18 Hole 8:30 am EASTERN TIME Tee Off *Site Fee $35 for Golf, Lunch and Cart Saturday, June 23, 2018 Triathlon Triathlon 400M Swim, 20K Cycling, 5K Road Race *Site Fee $60 through June 6th Register for Triathlon Saturday, August 4, 2018 Evansville, IN 10K Road Race 10K Run 7:00 am CST *Site Fee $20 through July 28. Saturday, September 8, 2018 Volleyball Noblesville, IN Volleyball Team captains must fill out team roster. Cannot guarantee placement on team. Sunday, Sept. 9, 2018 Noblesville, IN Archery Barebow Compound Compound Release 9:00 am Barebow Recurve Recurve Eastern Time Compound Fingers Individual Waiver & Release Form Sign Below WAIVER AND RELEASE OF LIABILITY In consideration of being permitted to enter for any purpose any RESTRICTED AREA (herein defined as the areas to which admission by general public spectators is prohibited), or being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in the event, EACH OF THE UNDERSIGNED, for himself, his personal representatives, heirs, next or kin, acknowledges, agrees, and represents that he has, or will immediately upon entering any of such restricted areas, and will continuously thereafter, inspect such restricted area or areas and all portions thereof which he enters and with which he comes in contact, and he does further warrant that his entry upon such restricted area or areas and his participation, if any, in the event constitutes an acknowledgment that he has inspected such restricted area and that he finds and accepts the same as being safe and reasonably suited for the purposed of his use, and he further agrees and warrants that if, at any time, he is in or about restricted areas and he feels anything to be unsafe, he will immediately advise the officials of such and will leave the restricted area(s): 1. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the Indiana State Games, Inc., the promoters, other participants, operators, officials, any persons in a restricted area, sponsors, advertisers, owners and lessees of premises used to conduct the event and each of them, their officers and employees, all for the purposes herein referred to as "releasee", from all liability to the undersigned, his personal representatives, assigns, heirs, and next of kin for all damages, and any claim or demands therefore on account of injury to the person or property or resulting in any and all death of the undersigned, whether caused by the negligence of the releasees or otherwise while the undersigned is in or upon the restricted area, and/or, competing, officiating in, observing, or working for, or for any other purpose participating in the event; 2. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the releasees and each of them from any loss, liability, damage, or cost they may incur due to the presence of the undersigned in or upon the restricted area or in any way competing, officiating, observing, or working for, or for any purpose participating in the event and whether caused by the negligence of the releasees or otherwise. 3. HEREBY ASSUMES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH OR PROPERTY DAMAGE due to the negligence of releasees or otherwise while in or upon the restricted area and/or while competing, officiating, observing, or working for, or for any purpose participating in the event. 4. EACH OF THE UNDERSIGNED expressly acknowledges and agrees that the activities at the event and in the restricted areas are dangerous and involve the risk of serious injury and/or death and/or property damage. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity and agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agrees that no oral representations, statement or inducement apart from the forgoing written agreement have been made. The waiver, release and indemnification agreement specifically embraces each and every event sanctioned, authorized or promoted by said releasee during the entire season and applies to each and every event, training, club or activity herein above mentioned, and has the same effect as if executed after each and every activity or event in which the undersigned participates so that the parties herein intended to be released and indemnified shall be fully and effectively released and indemnified as to each and every event herein above described. I grant the Indiana State Games, Inc., its sponsors and affiliated venue locations the right to use my name and any pictures taken of me during the 2018 Indiana State Games without remuneration for the purpose of promoting Athletic Competition and Wellness. Signature:

4 TEAM ROSTER: Team Captain must fill in Team Roster. All team athletes MUST ALSO register individually with $35 Unlimited fee paid. TEAM NAME Age of Youngest Gender: Team Member: M F TEAM CAPTAIN First: Last: Select age bracket for Team: PHONE NUMBER ( ) ( ) BBall Team Roster Team must be on one Roster Sport: Basketball Volleyball FIRST NAME LAST NAME PHONE DOB Sponsor Thank You Please support our Sponsors! Anonymous Donor Morgan & Bley, Ltd. River Bend In-Kind Sponsors: Scheller s Cycling Faith Music Radio

5 Important Information (Keep Pages 5 & 6) WEBSITE INFORMATION: REGISTRATION Now - May 7, 2018 Athletes must register and pay all fees by May 7th, 2018 for all May events. Events later in the year have up to one week prior to that event to register. $5.00 Late fee if not postmarked by May 7th for May events only. Mail paper forms to: P.O. Box 6334, Evansville, IN confirmation will be sent to athletes once registration and payment is received. AGE DIVISIONS: Participate in 5 year increments: 50-54, 55-59, 60-64, etc. Age as of December 31, 2018 TEAMS: Team Captain must turn in Team Roster form. All team members must register Individually to be eligible to participate on team. Team roster deadline is May 7, 2018 for Basketball. Team members not registered, will not be eligible to participate on team event. All athletes on roster must pay individual registration fee. No exceptions. No onsite registration. Teams will be determined by the youngest player registered. Participants must be 50 by Dec 31, CELEBRATION OF Friday, May 18 5:30 pm (CST) Tropicana Hotel Evansville - Walnut Room ATHLETES: Must RSVP 421 NW Riverside Dr. Parking in Parking Garage Free to Athletes $15 per guest Door Prizes!! Vendors!! Packet Pick up Available at Celebration Event CHECK-IN FOR EVENTS: Check in at your first event, up to one hour prior to event start time. PACKET PICK UP: Host Hotel Only Tropicana Evansville 421 NW Riverside Drive, Evansville, IN Meeting Room D Entrance off Ingle Street Packet Pick up at Hotel Wed., May 16th Wed., May 23rd 7:30am 7:00 pm (CST) Packets will only be available at Tropicana Host Hotel. Packets will not be mailed. REGISTRATION INCLUDES: RECOMMEND FRIEND: $35 Registration fee includes unlimited entry to events, goodie bag, commemorative t-shirt, Celebration of Athlete s Dinner and reception on May 18th, lunch at Recreation day on May 24th, & enter drawing for a FREE 2019 Indiana State Games. $5.00 Additional Fee for each: Track & Field, Swimming to cover expenses. *Site fee to be paid onsite at time of event. Bowling*, Golf* Must also register online for these two events: Triathlon*, 10K Road Race* Recommend a NEW participant to the Indiana State Games, when your friend registers, you re entered into a drawing for $50 Cash! RESIDENCY: AWARDS: Indiana State Games are open to all residents, including out-of-state residents. The state an athlete resides in for at least six months out of the year is considered to be his/her state of residence. Awards/Medals will be provided at the completion of each sporting event. Medals to all 1st, 2nd, 3rd place athletes by age category & gender. Medals will NOT be mailed. Most events 1st 4th advance to National Senior Games. Out of State Participants receive medals. CANCELLATION: Indiana State Games reserves the right to cancel or change any scheduled events at any time. QUESTIONS: Call Toll Free

6 All May Evansville Events are CENTRAL STANDARD TIME ZONE. Athlete Information-Schedule of Events (Keep pages 5 & 6)

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