2018 Canada 55+ Games August 21st-24 th Saint John, NB Participant & Non-Participant Registration Form

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1 PEI Registration Deadlines- May 31 (Hockey and Curling), all other events June 25th Cheque Payable to : PEI 55+ Games Society Send Registration form complete with payment to: Ernie Stavert, 198 Cornwall Road, Cornwall, PE C0A1H4 Contact , - eandrstavert@gmail.com OR drop off at Sport PEI, 40 Enman Cres, Charlottetown Team Shirt Sizing: XS S M L XL XXL Fee: $15 SECTION 1 Personal Information (PLEASE PRINT CLEARLY) Last Name First Name Address City/Town Province/Territory Postal Code Home phone number Cell phone number Gender Male Female Birth Date (mm/dd/yy) Age (as of December 31, 2018): Any dietary/mobility requirements: SECTION 2A Registration Fees NON REFUNDABLE OTHER THAN A SUBSTANTIATED MEDICAL CONDITION Please check by amount paid Participant Member: ($ $18.75 HST15% = $143.75) (AB, BC, MB, NB, NS, ON, PE, SK, YT, NT, PQ) Participant Non-Member: ($ $20.25 HST 15% = $155.25) (NL, NU) Non-Participant: ($ $12.75 HST 15% = $97.75) SECTION 2B Additional Fees (Team Captain/Coach/Skip submit Roster & Fee) Please check by amount paid Hockey Team Registration ($150 per team) Slo-Pitch Team Registration ($150 per team) Curling Team Registration ($100 per team includes 1 hour practice) Golf Fee ($ per participant includes practice round and golf cart) **Registration includes: Two (2) to Four (4) days of competition (depending on event / sport), transportation (arrival & departure from airport / bus to hotel, hotel to venue and venue to hotel, Opening Ceremonies / Welcome Lunch, Closing Ceremonies / Gala Dinner) and some evening entertainment**

2 SECTION 3 Travel and Accommodations (MUST COMPLETE) Arrival date(mm/dd/yy) Time: a.m. p.m Car Bus RV Ferry Air - Flight # (Saint John leg) I require transportation on arrival at the ferry/airport: yes no Departure date: Flight # Time: a.m. p.m. I require transportation on departure to the ferry/airport (August 25): yes no Accommodation I will be staying in a Hotel/Motel RV Park Campground Other Name of Accommodations: During the Games - August I require internal transportation during the Games yes no Wheelchair transit during the Games: yes no *Air Canada is the official airline-promo Code 37RQDDZ1 for 15% discounts flex fares & up. SECTION 4 Special Events Participant/Non-Participant I will be attending Opening Ceremonies (morning of) on Tuesday, August 21: yes no I will require transportation to/from opening ceremonies: yes no I will be attending the Closing Banquet (starting at 6:00pm) on Friday, August 24: yes no I will require transportation to/from closing banquet(4-6pm): yes no SECTION 5 Event and Sport (FOR PARTICIPANT ONLY EVENT MAY NOT BE CHANGE AFTER REGISTRATION DEADLINE) Last Name First Name Prov/Terr Category Age: Please check off the Event for which you are registering: Candle Pin Bowling Singles (Scratch) Average Singles (POA) Average Team* Average Captain: 8-Ball - Individual Badminton Bocce Pairs Partner Fours 3 Partners (Pairs only if not enough teams of four) Cribbage - Partner:

3 Contract Bridge - Partner: Cycling (can only compete in competitive or recreation) Competitive Time Trial (40Km) Road Race (60Km) (70+ 50Km) Recreation Time Trial (10Km) Road Race (20Km) (70+ 15Km) Darts Singles Women s Partner Men s Partner Mixed Partner Duplicate Bridge - Partner: Floor Shuffleboard - Partner: Golf Low Gross Low Net^ Calloway - ^CPGA Handicap Horseshoes Women s Men s A-50% and over B-35% to 49.9% C-20% to 34.9% D-0%-19.9% Ice Curling* Men's Women's Mixed - Skip: Ice Hockey* Men's Women's Team Name Lawn Bowls Captain: Pickleball Scrabble (select only one) Slo-Pitch* Open (men s) Team Name: Mixed Captain:

4 Swimming (Maximum 4 + relay relay teams formed on site) Tennis 50m Freestyle 100m Freestyle 100m Individual Medley 50m Backstroke 100m Backstroke 50m Breaststroke 100m Breaststroke 50m Butterfly 100m Predicted Time 200m Predicted Time Fun Relay (non-medal) Track & Field (Maximum 4 + relay relay teams formed on site) 50m 100m 200m 400m 800m 1500m 3000m Javelin Discus Triple Jump Shot Put Long Jump 400m Predicted Walk 1000m Predicted Walk Fun Relay (non-medal) Whist Partner Bonus Events 5 km 10 km Each participant can enter 1 main event plus the 5K and 10K, *Team Roster Form is required, and is to be submitted only by the Team Captain/Coach/Skip. All other players are to include only the name of the Team Captain/Coach/Skip. For Games rules visit

5 SECTION 6 Compulsory Participant/Non-Participant Waiver and authorization to use written materials/photographs/videography The following agreement contains important provisions which limit the Liability of the organizers in the event of an injury, property damage or death, and must be signed as a condition of participation in the 2018 Canada 55+ Games. Authorization to use written materials/photographs/videography I hereby authorize the Canadian Senior Games Association (CSGA) and the Host Committee for the 2018 Canada 55+ Games in Saint John, NB to use, reproduce and/or publish photographs as described below, that may pertain to me. I understand that this material will only be used in a display website and/or written publication that will be used to promote the 2018 Canada 55+ Games in particular and the CSGA in general. This authorization is continuous and may only be withdrawn by my specific rescinding of this authorization. Description of Material: Photograph(s) and/or printed material to be used to produce a display for exhibits, websites, trade shows and publicity for the 55+ Games in general, both nationally and at the provincial/territorial level. Release, Waiver and assumption of Risk I, the undersigned, hereby acknowledge that participation in the 2018 Canada 55+ Games and/or playoffs might result in personal injury, property damage or loss, and possibly death. I fully understand these risks and hereby agree to participate in the above mentioned Games at my own risk. In consideration of the 2018 Canada 55+ Games, I and my heirs, executors, administrators and assigns agree not to hold the various sites where the Games are being played, SJ 2018 Canada 55 + Games Inc. or the Canadian Senior Games Association (CSGA), or any of their servants, agents, sponsors, volunteers or employees responsible for any personal injury, property damage or loss, death resulting from or in connection with affiliated programs initiated, conducted or organized by the SJ 2018 Canada 55+ Games Incp. I have carefully read this Release, Waiver, Assumption of Risk Agreement and authorization. I fully understand said agreement and I am freely and voluntarily executing the same. Signature of Participant/Non-Participant Name of Participant/Non-Participant (please print) Date Saint John Canada 55+ Games - Office Use Only Received By: Date: Status: Incomplete Complete