2016 FLORIDA SENIOR GAMES Saturday, December 10, 2016

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1 Ross Norton Recreation Complex 1426 S. Martin Luther King Jr. Avenue Clearwater, Florida FLORIDA SENIOR GAMES Saturday, December 10, 2016 From US Highway 19: Take Belleair Rd west for 3.7 miles to S. Martin Luther King Jr. Avenue. Turn right onto S. Martin Luther King Jr. Avenue and the center is on the left. From north of Gulf to Bay, take Gulf to Bay to Martin Luther King Jr. Avenue. Turn left onto S. Martin Luther King Jr. Avenue and the center is on the right. Check-in Teams should be prepared to check-in at least 45 minutes prior to their first scheduled game. Final rosters can be submitted at this time and may not be changed once the first game has begun. Changes to original rosters at time of registration must be submitted in writing. There will be no changes made following the tournament. All teams/players must submit an official waiver signed by all players present and an official housing form must be submitted for each individual on the roster. Forms have been provided below for your convenience.

2 Women's 50+ Broward Heat 2 MD 28.5 Michigan Spirits Steel Cans 12:30pm 1 Broward Heat 2 VS MD :30pm 2 Michigan Spirits VS Steel Cans 2:00pm 1 Broward Heat 2 VS Michigan Spirits 2:00pm 2 MD 28.5 VS Steel Cans 3:30pm 1 Broward Heat 2 VS Steel Cans 3:30pm 2 MD 28.5 VS Michigan Spirits 5:00pm 1 W50 #1 Gold Medal Game VS W50#2 5:00pm 2 W50#3 Bronze Medal Game VS W50 #4 Women Broward Heat #1 55+ Village Seabreeze 60+ Village 65 1:15pm 1 Broward Heat 1 Village Seabreeze 2:45pm 1 Broward Heat 1 Village 65 4:15pm 1 Broward Heat 1 Village Seabreeze

3 Men 50+ & 55+ St. Pete Ballers 50+ Alper JCC 50+ Grey Beards 50+ Still Here 55+ 5:45pm 1 St. Pete Still Here 6:30pm 1 Still Here Grey Beards 6:30pm 2 St. Pete Alper JCC 7:15pm 1 Alper JCC Grey Beards 8:00pm 1 St Pete Grey Beards 8:00pm 2 Alper JCC Still Here 9:00pm 1 9:00pm 2 Men 50+ & 55 Gold Game Men 50+ & 55 Bronze Game

4 Men 60+ Blazers KFC Polk Players St. Pete 60 1:15pm 4 St. Pete 60 Blazers 2:45pm 4 KFC Polk Blazers 4:15pm 4 KFC Polk St. Pete 60 #1 seed #2 seed Court 5:45pm #3 seed Court 7:15pm Champion Format: A round robin will be played to determine seeding for the single elimination bracket. Medals will be awarded according to completion of the bracket.

5 Men 65+ Code Blue Marionfab 4 Venice Lime 1:15pm 3 Marionfab4 Venice Lime 2:45pm 3 Code Blue Venice Lime 4:15pm 3 Code Blue Marionfab4 #1 seed #2 seed Court 5:45pm #3 seed Court 7:15pm Champion Format: A round robin will be played to determine seeding for the single elimination bracket. Medals will be awarded according to completion of the bracket.

6 Men 70+ Bucket Makers Code Blue Clearwater Aces 1:15pm 2 Clearwater Aces Code Blue 2:45pm 2 Bucket Makers Code Blue 4:15pm 2 Bucket Makers Clearwater Aces #1 seed #2 seed Court 5:45pm #3 seed Court 7:15pm Champion Format: A round robin will be played to determine seeding for the single elimination bracket. Medals will be awarded according to completion of the bracket.

7 Men 75+ & 80+ Limestone Cowboys 75+ Village Gold 75+ St. Augustine 75+ Oldest City :30pm 3 Limestone Oldest City 12:30pm 4 St. Augustine Village Gold 2:00pm 3 St. Augustine Oldest City 2:00pm 4 Limestone Village Gold 3:30pm 3 Limestone St. Augustine 3:30pm 4 Village Gold Oldest City 5:00pm 3 Men Gold Game 5:00pm 4 Men Bronze Game

8 2016 FLORIDA SENIOR GAMES Hotel Survey Please complete this survey and bring it with you to check-in. Athlete Name: Sport(s) participated in: Arrival Date: Departure date: # of Rooms: Please Indicate at Which Hotel(s) You Stayed During the Games Clarion Inn & Suites Clearwater Comfort Inn & Suites Clearwater Ulmerton Comfort Suites Clearwater-Dunedin Courtyard by Marriott Madeira Beach Fairfield Inn Clearwater Hampton Inn Clearwater Central Hampton Inn & Suites Largo Holiday Inn Express & Suites Largo Innisbrook Golf & Spa Resort La Quinta Inn & Suites Clearwater Central Magnuson Clearwater Central Quality Beach Resort Quality Inn Clearwater Central Other: We are always trying to make your stay better. Please rate your stay 1-10 (circle one) 1 being the worst and 10 being the best Comments(optional):

9 Florida Senior Games Basketball 3-on-3 Roster Check List Team Name Local Qualifier FEMALE Age Division MALE Roster Qualified Didn't Qualify (3) Out of State (1) Remove Replacement Max for a roster is 10. Team rosters shall be limited to 10 persons, including non-playing coaches, non-playing captains & non-playing bench personnel. Changes shall be allowed only as permitted under Rule F of the Florida International Senior Games & State Championship rules of competition. F. TEAMS A maximum of three (3) players may be added to a roster following qualification at a Florida Local Senior Games Qualifier. Players and/or coaches added after qualification at a Florida Local Senior Games Qualifier do not have to participate at a Local Senior Games Qualifier.

10 Team Agreement, Release and Waiver of Liability In consideration of being permitted to participate in or assisting others in participating in the Florida Senior Games Games, and related events and activities, on behalf of myself, or a minor child or ward, heir, next of kin, personal representative, successor or assign; (1) I ACKNOWLEDGE, UNDERSTAND, DECLARE AND AGREE THAT: (a) To the best of my knowledge, I am in Good Physical Condition and have no disease or injury that would be aggravated by participating in activities related to the Games; (b) Participating or assisting others in participating in the Games may involve RISK OF INJURY TO ME, INCLUDING DEATH, LOSS OR DAMAGE TO ME OR MY PROPERTY, or other consequences, which might result not only from my own actions, inaction or negligence but also the actions, inaction or negligence of others, the rules of play, or the conditions of the premises or of any equipment used; (c) There may be OTHER RISKS not known or not reasonably foreseeable; and Understanding All of the Above, (2) I ASSUME ALL OF THE ABOVE RISKS AND RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, INDEMNIFY AND COVENANT NOT TO SUE: (a) the State of Florida or any of its agencies, Enterprise Florida, Inc., and the Florida Sports Foundation, Inc., their commissioners, employees or volunteers, coaches, trainers, officials affiliated with the international organizations, agencies, sponsors, or advertisers, the respective administrators, officers, directors, agents, representatives, employees, volunteers, coaches, trainers, officials or any other individuals affiliated with the Games; (b) any affiliated subsidiary, successor, organization, or related companies or businesses, other participants, participating or sponsoring municipalities, governmental agencies, international organizations, agencies, sponsors, or advertisers, the respective administrators, officers, directors, agents, representatives, employees or volunteers of such entities or organizations; (c) the National Senior Games Association (NSGA) and/or their respective representatives, officers, directors, employees, agents, successors and assigns; (d) owners, lessors and lessees of premises used to conduct the Games FROM ANY AND ALL LIABILITY FOR INJURY, INCLUDING DEATH, LOSS OR DAMAGE TO PERSON OR PROPERTY, OR ANY OTHER CONSEQUENCE in connection with entry in or arising out of participation in, performance in or lack of performance in, including travel en route to and from the Games. (3) I FURTHER AGREE THAT: (a) Prior to participating as an athlete, I, or in the case of a minor, a parent or guardian, will INSPECT the facilities and equipment to be used, and if I believe same to be unsafe, I will immediately REPORT such condition(s) to the athletic coach, supervisor, or official connected with the Games of same and either DECLINE TO PARTICIPATE or ASSUME THE RISK of participating; (b) I will ALLOW my PHOTOGRAPH, PICTURE or LIKENESS and/or VOICE to APPEAR in any official documentary, promotional (including any and all advertisements), television, radio or film coverage of the Games, WITHOUT COMPENSATION. (c) I acknowledge and agree to the Florida Sports Foundation (FSF) refund policy. No refunds will be granted for withdrawals made less than seven (7) days prior to the start of competition. Late or on-site entries made less than seven (7) days prior to the start of competition are non-refundable. Any registration approved for a refund is subject to a $15 administrative fee. All refund requests must be submitted in writing to games@flasports.com no less than seven (7) days prior to the start of competition. No refunds will be granted for cancellation due to inclement weather or acts of god. Events cancelled due to lack of participation shall be refunded upon written request to games@flasports.com received no more than seven (7) days following the end of scheduled competition. (4) I CONSENT TO ALL EMERGENCY MEDICAL TREATMENT as may be deemed appropriate under existing circumstances by medical personnel or personnel associated with the Games. I HAVE READ THIS FORM IN ITS ENTIRETY AND HAVE PROVIDED TRUTHFUL INFORMATION. Printed Name Si gnature Pri nted Name Si gnature All participants on roster must complete the Agreement, Release and Waiver of Liability in order to compete in the Florida Senior Games. Team waiver form is due on-site at designated check-in time. Teams will not be permitted to compete without a completed form signed by all rostered playing and non-playing participants.

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