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2 2014 TEAM ROSTER COACH/CAPTAIN MUST SUBMIT THE TEAM ENTRY. EACH TEAM MEMBER MUST Team SUBMIT Name: HIS/HER INDIVIDUAL ENTRY FORM WITH FEES IN ORDER Age Group: TO PARTICIPATE ON THE TEAM. Note: The age is determined by the youngest team member, see age group on page 3. Captain s Name: Home Phone Cell Phone Captain s Address [ ] Basketball 3 on 3 [ ] Male [ ] Female [ ] Softball 10 Player Team [ ] Volleyball 6 Player Team [ ] Male [ ] Female [ ] Team Dance 8-15 Per Team [ ] Advanced [ ] Recreational [ ] Line Dance Team Roster 1 Player Name: Age: D.O.B. Home No: Cell No: 2 Player Name: Age: D.O.B. Home No: Cell No: 3 Player Name: Age: D.O.B. Home No: Cell No: 4 Player Name: Age: D.O.B. Home No: Cell No: 5 Player Name: Age: D.O.B. Home No: Cell No: 6 Player Name: Age: D.O.B. Home No: Cell No: 7 Player Name: Age: D.O.B. Home No: Cell No: 8 Player Name: Age: D.O.B. Home No: Cell No: 9 Player Name: Age: D.O.B. Home No: Cell No: 10 Player Name: Age: D.O.B. Home No: Cell No: 11 Player Name: Age: D.O.B. Home No: Cell No: 12 Player Name: Age: D.O.B. Home No: Cell No: 2
3 LOUISIANA SENIOR OLYMPIC GAMES 2014 Games Coordinators: Janey Perez (504) Bernice Bordelon (504) LSOG Website lsog1.net GENERAL ENTRY INFORMATION The 2014 Louisiana Senior Olympic Games are hosted by Greater New Orleans District Senior Olympics and Jefferson Parish DATES: Saturday, August 24 through Saturday, November 15, 2014 REGISTRATION: Return the attached entry form, fee payment and signed liability waiver by entry deadline. Form should be postmarked by the event deadline. NO EXCEPTIONS FEES: Entry Fee (for three (3) sports)* $ Each additional sport $ 5.00 *Official t-shirt and banquet are included. ADDITIONAL fees are REQUIRED if you sign up for the following sports: Golf $ Bowling (per event) $ 8.00 Tennis $ 5.00 Miniature Golf $ 6.00 Additional banquet guests: Each $ K Run & Race Walk $ K Run Middendorf s $ ELIGIBILITY: Any person 50 years or older as of December 31, 2014 is eligible to participate. Athletes 40 and over may sign up for Track & Field events. AGE GROUPS: 50-54; 55-59; 60-64; 65-69; 70-74; 75-79; 80-84; 85-89; 90+. Age groups are determined by age as of December 31, Age divisions for doubles/teams determined by youngest partner/member. YOU ARE TO SHOW UP AT YOUR EVENT UNLESS NOTIFIED BY GAME ORGANIZERS. PLEASE CHECK THE WEBSITE FOR ANY CHANGES AND START TIMES FOR YOUR AGE GROUP EVENT SELECTION: It is the responsibility of the participants to carefully select their events, considering possible overlap. Event start times will be strictly enforced. Absentees will be scratched. CANCELLATIONS/ POSTPONEMENTS: Game officials reserve the right to cancel or postpone events due to inclement weather, unusual circumstances or insufficient entries. All changes in the scheduled events will be posted to ENTRY DEADLINE: Check your individual event. No refunds given after posted event deadline. NO EXCEPTIONS!!! AWARDS: Medals will be presented to first through third place individual winners in-state and actual order for out-ofstate participants. TEAMS AND DOUBLES: Each member must submit an individual signed application, release and entry fee. Team captains must submit a team roster for the team to be eligible for team competition. PARTNER FIND Are you looking for a partner in a sport that is doubles or four to a team? In most cases, the venue coordinator will make every effort to find you a partner. You may contact the coordinator before the event (all coordinators and their phone numbers are listed in this packet); however, this is not necessary. Every effort will be made to place you with someone. GUESTS: Family and friends are welcome and encouraged to attend all competitive events free of charge. 3 3
4 EVENT ADDRESS AND PHONE NUMBER INFORMATION PLEASE CHECK THE WEBSITE FOR CHANGES AND START TIMES FOR YOUR AGE GROUP EVENT SITE ADDRESS CITY, ZIP PHONE Belle Terre Playground 5600 Belle Terre Rd. Marrero, Bridge City Playground th St. Bridge City, Capitano s Tennis & Athletic Club 5524 Yale St. Metairie, City Park Practice Track City Park 12 Palm St. New Orleans, City City Park 8 Victory Ave. New Orleans, Colonial Lanes 6601 Jefferson Hwy. Harahan, Coquille Park Highway 1085 Covington, Elmwood Fitness Center 1200 South Clearview Harahan, Forrest Community Park S.Harrel s Ferry Rd. Baton Rouge, Four Columns 3711 Westbank Expy. Harvey, Gerry s Place 1096 Behrman Highway Gretna, Harahan Playground th St. Harahan, Jefferson Playground 4100 South Dr. Jefferson, Lakewood Golf & Country Club 4811 Gen. DeGaulle Dr. New Orleans, LA. Wildlife & Fisheries 4142 N. Flannery Rd. Baton Rouge,70814 Lasalle Park 6600 Airline Dr. Metairie, Little Farms Playground South Park. St. River Ridge, Middendorf s Hwy. 51 South Akers, Miley Playground 6716 W. Metairie Ave. Metairie, Pontiff Playground 1521 Palm St. Metairie, Shooters Club 2338 Hickory Ave. Harahan, University of N. O. Aquatic Center 6801 Franklin Ave. New Orleans, Waggaman Gym & Horseshoe Pits 516 Dandelion Dr. Waggaman, Westbank Bridge Park LA 18 under I-310 Bridge Luling, For directions to any event location, please call the event coordinator or check the website. PLEASE CHECK THE WEBSITE FOR ANY CHANGES AND START TIMES FOR YOUR AGE GROUP YOU ARE TO SHOW UP AT YOUR EVENT UNLESS NOTIFIED BY GAME ORGANIZERS YOU WILL NOT RECEIVE CONFIRMATION 4
5 INDIVIDUAL ENTRY/ PARTICIPANT WAIVER FORM RETURN THIS FORM, AFTER COMPLETING AND INCLUDE ALL FEES Mail to: Louisiana Senior Olympic Games, P.O. Box 6255 Metairie, LA Last Name: First Name: MI Address: State: Zip: Parish: City: Home Phone: Cell Phone: [ ] Male [ ] Female Age as of 12/31/14 Date of Birth: / / PARTICIPANT WAIVER SIGN BELOW In consideration of being allowed to participate in any way in the Louisiana Senior Olympic Games program, related events and activities, the undersigned acknowledges, appreciates and agrees that: 1. The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to me does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES, or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in my readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, for myself and on behalf of my/or heirs, assigns, personal representatives and next of kin, HEREBY RELEASE the Louisiana Senior Olympic Games, its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event ( Releasees ), with RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. INDEMNIFY AND HOLD HARMLESS all of the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I, the undersigned participant, grant to the Louisiana Senior Olympic Games the right to use any pictures taken of me during the Louisiana Senior Olympic Games without my remuneration and in any medium the photographer/staff sees fit for art, advertisement, exhibition, editorial, or any purpose whatsoever. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. I UNDERSTAND MY ENTRY FORM MUST BE POSTMARKED BY THE EVENT REGRISTRATION DEADLINE ON THIS FORM PRINT NAME: SIGNATURE: DATE: EMERGENCY CONTACT: PHONE: 5
6 2014 ENTRY FEE SCHEDULE RETURN THIS PAGE with CHECK or MONEY ORDER with fees to: Louisiana Senior Olympic Games, P.O. Box 6255 Metairie, LA Entry fees must be sent with this form to be eligible. Entry Fee (allows participation in up to 3 Sports): $30.00 $ $5.00 for each additional sport: x $5.00 $ Sports Requiring an Additional Fee over the Entry Fee: Golf Fee: $ $ Bowling Fee: (Singles, Doubles or Mixed Doubles) each $ 8.00 $ Tennis Fee: (Balls Provided) $ 5.00 $ Miniature Golf (36 Holes) $ 6.00 $ *5-K Run / Race Walk ( SEE *Note below) $ $ 80+ call Bill Elrod for discount **10-K Run 80+ call Bill Elrod for discount $ $ I WILL ATTEND THE BANQUET: [ ] YES [ ] NO Included (Participants must check in at the door) I will bring $5.00 each PAYABLE AT DOOR ONLY Pay at door To Help Support the LSOG 2014 games, I have enclosed a donation of $ (All donations are tax deductible) TOTAL AMOUNT ENCLOSED *ALLIGATOR FESTIVAL 5K Run/Race Walk: LSOG will enter you in the NORSI Event. Get both shirts on the day of the race. Scenic race on historic Mississippi River Levee with entry to the festival **MIDDENDORF S MANCHAC RUN 10K LSOG will enter you in the NORSI Event. Get both shirts on the day of the race. A scenic run with a bridge challenge at the start and finish. Enjoy a catfish dinner party. $ Make Checks Payable to: L.S.O.G. Check T-shirt size preference [ ]S [ ]M [ ]L [ ]XL [ ]2XL [ ]3XL **********LATE REGISTRATION WILL NOT BE ACCEPTED********** Mail Entry Form and Fees to: LSOG P.O. Box 6255 Metairie, LA (Include pages 5, 6, 7 and 8. Team Captain turns in page 2.) 6
7 OFFICIAL 2014 LSOG ENTRY FORM 2014 INDIVIDUAL EVENTS (Return this page with your entry) ROAD RACES SWIMMING [ ] Female [ ] Male [ ] 5K Run [ ] 5K Race Walk [ ] 10K Run Events listed in order as they will occur on day of the event. GATOR STOMP MIDDENDORF/MANCHAC RUN Women precede men. Check up to 6 events. (Only 5 for USMS times) ALLIGATOR FEST RUN USMS# Event Seed Time Both events are run by New Orleans Running Systems Inc. [ ] 100y Butterfly NOTE: If you Register for these events through LSOG [ ] 50y Freestyle you will receive both the NORSI race T-Shirt and the [ ] 100y Breaststroke LSOG T-Shirt with entrance to LSOG Banquet which [ ] 200y Backstroke includes food and entertainment. More info page 11 [ ] 200y Freestyle [ ] 50y Butterfly [ ] ARCHERY [ ] Barebow [ ] 50y Breaststroke [ ] Compound Barebow [ ] Recurve Barebow [ ] 200y Individual Medley [ ] Compound Fingers [ ] Compound Release [ ] 100y Backstroke [ ] 100y Freestyle [ ] BADMINTON [ ] Singles [ ] 100y Individual Medley [ ] Doubles [ ] Mixed Doubles [ ] 50y Backstroke [ ] 200y Breaststroke [ ] BASKETBALL [ ] 500y Freestyle [ ] 3 ON 3 TRACK & FIELD EVENTS [ ] BILLIARDS Track Events Field Events [ ] 50m Dash [ ] Long Jump [ ] BOWLING [ ] Singles [ ] 100m Sprint [ ] High Jump [ ] Mixed Doubles (Partner ) [ ] 800m Race Walk [ ] Discus [ ] Doubles (Partner ) [ ] 800m Run [ ] Javelin [ ] 200m Run [ ] Shot Put [ ] CYCLING [ ] 5K [ ] 10K [ ] 20K [ ] 40K [ ] 1500m Race Walk [ ] Hammer Throw [ ] 400m Run [ ] Pole Vault [ ] DANCE (Team) [ ] 1500m Run [ ] Triple Jump [ ] GOLF Individual Stroke Play [ ] TABLE TENNIS (Ping Pong) [ ] Singles [ ] Doubles (Partner ) [ ] HORSESHOES [ ] Mixed (Partner ) [ ] MINIATURE GOLF [ ] TENNIS [ ] Singles [ ] Doubles (Partner ) [ ] PICKLEBALL [ ] Singles [ ] Mixed (Partner ) [ ] Doubles (Partner ) [ ] Mixed (Partner ) [ ] THROWS [ ] Football Accuracy [ ] Softball Accuracy [ ]RACQUETBALL [ ] Singles [ ] Frisbee Accuracy [ ] Softball Distance [ ] Doubles (Partner ) [ ] Basketball Free Throw [ ] Mixed (Partner ) [ ] WASHER PITCH [ ] SHOOTING [ ] Pistol [ ] Rifle [ ] WEIGHTLIFTING [ ]Bench Press [ ]Dead Lift [ ]Arm Curl [ ]Clean & Jerk [ ] SHUFFLEBOARD [ ] Singles [ ] Doubles (Partner ) 7
8 OFFICIAL 2014 LSOG ENTRY FORM 2014 TEAM EVENTS FOR INDIVIDUALS EACH COACH OR CAPTAIN MUST SUBMIT THE TEAM ROSTER FORM ON PAGE 2 BY THE EVENT REGISTRATION DEADLINE TO PARTICIPATE. INDIVIDUAL PLAYERS COMPLETE THIS FORM TO INDICATE THE TEAM YOU ARE PLAYING WITH. ROSTERS MUST BE SUBMITTED WITH THE CAPTAIN/COACH S ENTRY FORM Basketball 3 on 3 M or F Age Group Team Name Captain s Name Softball M or F Age Group Team Name Captain s Name Volleyball M or F Age Group Team Name Captain s Name Team Dance Advanced Recreational Line Dance Age Group determined by team average Team Name Captain s Name *Golf foursome Player 1: Player 2: PHONE ( ) PHONE ( ) Player 3: Player 4: PHONE ( ) PHONE ( ) *You will be placed in a foursome if you need one 8
9 OFFICIAL 2014 LSOG ENTRY FORM Event Check-in Start Date / Site Registration Deadline ARCHERY SATURDAY, September 20 SEPTEMBER 10 LA. WILDLIFE & FISHERIES Waddill Wildlife Refuge 8:00AM 9:00AM Jack Laws (225) Bill Rouyea (225) BADMINTON SATURDAY, October 4 SEPTEMBER 24 MEN/LADIES FORREST COMMUNITY PARK Singles, then Doubles 1:30PM 2:00PM BATON ROUGE Mixed Doubles Mike Maddox (225) BASKETBALL - LADIES SATURDAY, September 6 AUGUST 27 LITTLE FARMS PLAYGROUND 3 on 3 8:30AM 9:00AM Ann Hassenboehler (504) BASKETBALL - MEN SATURDAY, October 4 SEPTEMBER 24 LITTLE FARMS PLAYGROUND 3 on 3 8:30AM 9:00AM Bobby Johnson (504) BILLIARDS TUESDAY, September 23 SEPTEMBER 13 GERRY S PLACE 10:00AM 10:30AM Sonya Belgard (504) BOWLING (MIXED DOUBLES) THURSDAY, September 11 SEPTEMBER 2 $8.00 Fee COLONIAL LANES (504) 12:30PM 1:00PM Nova Dee Carbo & Joyce Plaisance Dee Joyce BOWLING (DOUBLES) FRIDAY, September 12 SEPTEMBER 2 $8.00 Fee COLONIAL LANES (504) 12:30PM 1:00PM Nova Dee Carbo & Joyce Plaisance Dee Joyce BOWLING (SINGLES) SATURDAY, September 13 SEPTEMBER 2 $8.00 Fee COLONIAL LANES (504) 12:30PM 1:00PM Nova Dee Carbo & Joyce Plaisance Dee Joyce CYCLING 40K SUNDAY, August 24 AUGUST 14 I-10 & HIGHWAY 51 (next to Cajun Pride Swamp Tours) 9:15AM 9:45AM Robin Robert (504) CYCLING 5K-10K-20K SATURDAY, September 6 AUGUST 27 I-10 & HIGHWAY 51 (next to Cajun Pride Swamp Tours) 7:30AM 8:00AM Robin Robert (504) DANCE (TEAM DANCE) SATURDAY, September 20 SEPTEMBER 10 HARAHAN GYM 1:30PM 2:00PM Starrlynne Morgan (504) GOLF MONDAY, September 29 SEPTEMBER 19 LAKEWOOD COUNTRY CLUB $50.00 Fee 7:30AM 8:30AM Janey Perez (504) John Wolken (504)
10 OFFICIAL 2014 LSOG ENTRY FORM Event Check-In Start Date/Site Registration Deadline HORSESHOES THURSDAY, September 25 SEPTEMBER 15 WAGGAMAN HORSESHOE PITS :00AM 9:30AM :30PM 1:00PM Landry & Jenny Camardelle (504) MINIATURE GOLF TUESDAY, September 23 SEPTEMBER 13 $6.00 Fee CITY CITY PARK $6.00 for 36 holes 10:00AM 10:30AM Howard Davenport (504) PICKLEBALL SATURDAY, September 6, 7* AUGUST 27 Doubles, Mixed Doubles COQUILLE PARK MADISONVILLE Singles 7:30AM 8:00AM Tom Burkhart * if necessary (225) RACQUETBALL SATURDAY, October 11 OCTOBER 1 ELMWOOD FITNESS CENTER Bring balls, equipment & lock 9:00AM 9:30AM AL Schof (225) SOFTBALL SATURDAY, September 13 SEPTEMBER 3 MEN & LADIES LASALLE PARK 9:30AM 10:00AM Henry Francalancia (504) SHOOTING MONDAY, September 22 SEPTEMBER 12 Rifle -.22 caliber bolt action single shot. SHOOTERS CLUB Bring one folding chair.22 caliber hand gun 9:00AM 9:30AM Ray Asprion (504) Revolver or semi-automatic pistol Bill Connick (504) SHUFFLEBOARD DOUBLES FRIDAY, September 26 SEPTEMBER 16 BELLE TERRE PLAYGROUND :30AM 9:00AM Darrell Acosta (225) :00PM 2:30PM Ted Matherne (504) SHUFFLEBOARD SINGLES SATURDAY, September 27 SEPTEMBER 17 BELLE TERRE PLAYGROUND Darrell Acosta (225) ALL AGES 8:30AM 9:00AM Ted Matherne (504) SWIMMING SUNDAY, October 5 SEPTEMBER 25 DICK BOWER MEMORIAL SWIM MEET UNO AQUATIC CENTER 9:00AM 10:00AM Ellen Hall (504) TABLE TENNIS FRIDAY, October 3 SEPTEMBER 23 (PING PONG) BRIDGE CITY PLAYGROUND 8:30AM 9:00AM Janey Perez (504) TENNIS SATURDAY, September 20 SEPTEMBER 10 CITY PARK/PEPSI TENNIS COURTS Fee $5.00 8:00AM 8:30AM Bill Pryor (504) YOU ARE TO SHOW UP AT YOUR EVENT UNLESS NOTIFIED BY GAME ORGANIZER 10
11 OFFICIAL 2014 LSOG ENTRY FORM Event Check-In Start Date/Site Registration Deadline THROWS THURSDAY, September 25 SEPTEMBER :00AM 9:30AM WAGGAMAN PLAYGROUND (504) :30PM 1:00PM Thais Lacrouts & Lucille Walker Thais Lucille TRACK & FIELD SAT. October 4/ (Rain: SUN. Oct 5) SEPTEMBER 24 CITY PARK PRACTICE TRACK Track Events 8:00AM 9:00AM (Sun. KINGS GRANT PLAYGROUND) Order of events to be determined by Coordinator Field Events 10:30AM 11:00AM Paul Bowman (504) VOLLEYBALL SATURDAY, September 6 AUGUST 27 JEFFERSON, PONTIFF, MILEY (captains will be notified) (captains will be notified) Janey Perez (504) WASHER PITCH WEDNESDAY, September 24 SEPTEMBER 14 BELLE TERRE PLAYGROUND MEN & LADIES 8:30AM 9:00AM Joyce Plaisance (504) WEIGHTLIFTING SUNDAY, October 5 SEPTEMBER 25 CAPITANO S TENNIS & ATHLETIC CLUB 10:30AM 11:00AM Sean Sellers (504) K RUN & RACEWALK GATOR STOMP SATURDAY, Sept. 27 $15.00 Extra ALLIGATOR FESTIVAL WESTBANK BRIDGE PARK LULING a NORSI event 8:00AM 9:00AM Bill Elrod (985) NOTE: This LSOG event is managed by New Orleans Running Systems. (NORSI) Senior Olympians register with LSOG and LSOG will take care of registering you with NORSI 10K RUN ENTRY DEADLINE SEPTEMBER 15 Pick up race packet on the levee in front of the Westbank Bridge Park. (Across River Road LA 18 from the park- Under I-310 Bridge) MIDDENDORF S/MANCHAC 10K SATURDAY, November 15 $20.00 Extra 7:00AM 8:00AM Bill Elrod (985) NOTE: This LSOG event is managed by New Orleans Running Systems. (NORSI) Senior Olympians register with LSOG and LSOG will take care of registering you with NORSI CELEBRATION OF ATHLETES BANQUET THURSDAY, SEPTEMBER 25, 2014 THE FOUR COLUMNS 6:30 PM PLEASE CHECK THE WEBSITE FOR ANY CHANGES AND START TIMES FOR YOUR AGE GROUP 11 ENTRY DEADLINE NOVEMBER 3 rd. Pick up race packet at Middendorf s on race day (I-55 Exit 15)
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