Event Registration Form, 2007 by ubb16013

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									                                         Event Registration Form, 2007
THURSDAY, July 26, 2007                      FRIDAY, July 27, (continued)            SATURDAY, July 28, (continued)
Triathlon                                    Track and Field                         Softball
  9:00 am     Swim, Bike, Run                 11:00 am    100 meter Race Walk          8:00 am  Softball Tournament
                                              11:00 am    Triple Jump
Cycling                                                                              Tennis
                                              11:15 am    200 meter Race Walk
                                                                                       8:00 am    Singles
  6:30 am     20K Road Race                   11: 30 am   800 meter Run
                                                                                       10:00 am   Doubles
  10:30 am    10K Time Trial
                                             Bowling                                              Partner________________
                                               9:00 am   Men’s Doubles                 12:00 noon Mixed Doubles
Golf
                                                         Partner_________________                 Partner________________
  7 to 11:00am Tee times, 18 Hole Golf
               Tournament                     12:00 noon Mixed Doubles
                                                                                     Track and Field
                                                         Partner_________________
                                                                                       8:00 am     50 meter Dash
Racquetball                                   3:00 pm Women’s Doubles
                                                         Partner_________________      8:15 am     400 meter Fun Walk
  8:00 am     Singles
                                                                                       9:00 am     1500 meter Race Walk
  9:30 am     Doubles
              Partner________________        Table Tennis                              9:30 am     400 meter Race Walk
                                               9:00 am Singles                         9:30 am     Discus Throw
Billiards                                     10:00 am Doubles                        10:00 am     Frisbee Throw
   9:00 am    8 Ball Singles                              Partner_________________     10:00 am    400 meter Dash
                                              11:00 am Mixed Doubles                   10:30 am    High Jump
Canoe Racing                                              Partner_________________     11:00 am    Shot Put
 10:00 am    Two person                                                                11:00 am    1500 meter Run
             Partner________________         Basketball                                11:30 am    Football Throw
                                               1:00 pm    Free Throw
Pickle Ball                                    1:30 pm    3 Point Shots              Disc Golf
  1:00 pm     Singles                          2:00 pm    Hot Shot                      9:00 am     Singles
  2:00 pm     Doubles                          3:00 pm    3 on 3, half court
              Partner________________                                                Bowling
  3:00 pm     Mixed Doubles                  Archery                                   9:00 am      Men’s Singles
              Partner________________          9:00 am    Compound Release Aid         2:00 pm      Women’s Singles
                                               9:00 am    Compound Fingers
Volleyball                                                Shooters                   Trap Shooting
  1:00 pm     Volleyball Tournament            9:00 am    Barebow Recurved             9:00 am     Singles, 16 yards
                                                           and Compound                            Doubles, 16 yards
Horseshoes                                                                                         Handicap, 19 to 27 yards
  1:30 pm     Singles                        Swimming
  2:00 pm     Doubles                          12:00 noon Warm-up period starts      Skeet
              Partner_______________           1:00 pm 50 meter Backstroke             1:00 pm    50 Targets, 4 gauges
                                               1:15 pm 25 meter Butterfly
Swimming                                       1:30 pm 50 meter Freestyle            Swimming
  12:00 noon Warm-up period starts             1:45 pm 25 meter El. Backstroke         1:00 pm    100 meter Breaststroke
   1:00 pm 1500 meter, Males                   2:00 pm 100 meter Freestyle             1:15 pm    50 meter Sidestroke
   2:00 pm 1500 meter, Females                 2:15 pm 100 meter Sidestroke            1:30 pm    100 meter IM
                                               2:30 pm 200 meter Backstroke            1:45 pm    25 meter Breaststroke
FRIDAY, July 27, 2007                          2:45 pm 50 meter El. Backstroke         2:00 pm    50 meter Butterfly
Cycling                                        3:00 pm 200 meter IM                    2:15 pm    200 meter Freestyle
  6:30 am     40 K Road Race                   3:15 pm 25 meter Backstroke             2:30 pm    100 meter Freestyle
  10:30 am     5 K Time Trial                                                                     Relay (4 person)
                                               3:30 pm 50 meter Breaststroke
                                                                                       2:45 pm     100 meter Butterfly
                                               3:45 pm 100 meter IM Relay
Road Race                                                                              3:00 pm     25 meter Freestyle
                                               4:00 pm 500 meter Freestyle
  7:00 am     10 K Run / Walk                                                          3:15 pm    200 meter Breaststroke
                                             Billiards                                 3:30 pm     25 meter Sidestroke
Track and Field                                 1:30 pm   8 Ball Doubles, Males        3:45 pm    100 meter Backstroke
  7:00 am 5000 meter Race Walk                            Partner________________      4:00 pm    Diving
  8:00 am 800 meter Fun Walk                   1:30 pm    8 Ball Doubles, Females
  8:30 am 200 meter Dash                                  Partner________________    Darts
  9:00 am Javelin                              1:30 pm    8 Ball Doubles, Mixed        1:30 pm     Singles
  9:00 am Standing Long Jump                              Partner________________
  9:30 am Softball Throw                                                             Badminton
  9:30 am 800 meter Race Walk                SATURDAY, July 28, 2007                   3:00 pm     Singled
  10:00 am Long Jump                         Road Race                                 4:00 pm     Doubles
  10:00 am 100 meter dash                      7:00 am     5K Run / Walk                           Partner________________
  11:00 am Pole Vault                                                                  5:00 pm     Mixed Doubles
                                                                                                   Partner________________
                                                 Schedule of Events
                                                                  2007

Wednesday, July 25, 2007                                                 Friday, July 27, 2007

Noon – 6:45 pm    Registration check-in and packet pick-up and           6:00 am – 5:00 pm    Registration packet pick-up, check-in,
                  information at north entrance of the Sheridan                               information and results at Sheridan
                  Senior Center, 211 Smith Street.                                            Senior Center, 211 Smith Street.
                                                                         11:30 am – 1:00 pm   Lunch at the Sheridan Senior Center
6:45 pm           Wyoming Senior Olympics Board and Annual
                  Membership Meeting at the Sheridan Senior              Cycling……………….Dayton and Ranchester, Wyoming
                  Center. Please enter at north door. All                6:30 am       40K Road Race, High School, Dayton
                  Wyoming Seniors are welcome!                           10:30 am      5K Time Trial, Middle School,
                                                                                        Ranchester.
Thursday, July 26, 2007
                                                                         Road Race……………Big Horn Women’s Club, Big Horn,
6:00 am – 5:00 pm Registration check-in and packet pick-up and                         Wyoming
                  information at the Sheridan Senior Center.             7:00 am       10K Run / Walk

11:30 am-1:00 pm Lunch, Sheridan Senior Center                           Track and Field……    Sheridan High School Track
                                                                         7:00 am              5000 meter Race Walk
Triathlon…………Sheridan Junior High School                                 8:00 am               800 meter Fun Walk
9:00 am      400 meter Swim, 12 mile Bike and 5 K Run                    8:30 am              200 meter Dash
                                                                         9:00 am               Javelin
Cycling……………Ranchester and Dayton, Wyoming                               9:00 am              Standing Long Jump
6:30 am     20K Road Race-Middle School, Ranchester                      9:30 am               Softball Throw
10:30 am    10K Time Trial-High School, Dayton                           9:30 am               800 meter Race Walk
                                                                         10:00 am              Long Jump
Golf………………. Kendrick Municipal Golf Course                               10:00 am              100 meter Dash
7:00 am-11:00 am Tee times. 18 Hole Tournament                           11:00 am             Pole Vault
                                                                         11:00 am             100 meter Race Walk
Racquetball……… Sheridan County YMCA                                      11:00 am             Triple Jump
8:00 am        Singles                                                   11:15 am             200 meter Race Walk
9:30 am        Doubles                                                   11:30 am             800 meter Run

Billiards………….. Sheridan Senior Center                                   Bowling………………Cloud Peak Lanes
9:00 am         8 Ball Singles                                           9:00 am      Men’s Doubles
                                                                         12:00 noon   Mixed Doubles
Canoe Races         Powder Horn Golf Course                              3:00 pm      Women’s Doubles
10:00 am            Two Person (Male, Female or Mixed)
                                                                         Table Tennis…………Sheridan County YMCA
Pickle Ball…………Sheridan County YMCA                                      9:00 am         Singles
1:00 pm        Singles                                                   10:00 am        Doubles
2:00 pm        Doubles                                                   11:00 am        Mixed Doubles
3:00 pm        Mixed Doubles
                                                                         Basketball…………… Sheridan County YMCA
Volleyball…………Sheridan County YMCA                                       1:00 pm         Free Throw
1:00 pm       Volleyball Tournament                                      1:30 pm         3 Point Shots
                                                                         2:00 pm         Hot Shot
Horseshoes………..Marshall Park                                             3:00 pm         3 on 3, half court
1:30 pm        Singles
2:00 pm        Doubles (Male, Female or Mixed)                           Archery………………Sheridan County Sportsmen’s
                                                                                      Club
Swimming………...Sheridan Junior High School Pool                           9:00 am      Compound Release Aid
12:00 noon    Warm-up period starts                                      9:00 am      Compound Fingers Shooters
1:00 pm       1500 meter swim, Male                                      9:00 am      Barebow Recurved and Compound
2:00 pm       1500 meter swim, Female
                                                                         Billiards…………… Sheridan Senior Center
Opening Ceremonies……….. Sheridan Senior Center                           1:30 pm        8 Ball Doubles, Males, Females
5:30 pm – 8:00 pm Parade of Athletes to Kendrick Park,                                  and Mixed
                  Dinner & Entertainment at Kendrick Park
Friday, July 27, 2007 Continued
                                                               Bowling……………...Cloud Peak Lanes
Swimming………….Sheridan Junior High School Pool                  9:00 am        Men’s Singles
12:00 noon   Warm-up period starts                             2:00 pm        Women’s Singles
1:00 pm      50 meter Backstroke
1:15 pm      25 meter Butterfly                                Trap Shooting……... Sheridan County Sportsmen’s Club
1:30 pm      50 meter Freestyle                                9:00 am            Singles, 16 yards
1:45 pm      25 meter Elementary Backstroke                                       Doubles, 16 yards
2:00 pm      100 meter Freestyle                                                  Handicap, 19 to 27 yards
2:15 pm      100 meter Sidestroke
2:30 pm      200 meter Backstroke                              Skeet…………………Sheridan County Sportsmen’s Club
2:45 pm      50 meter Elementary Backstroke                    1:00 pm     50 targets each with 12, 20, 28 and 410
3:00 pm      200 meter Individual Medley                                    gauge
3:15 pm      25 meter Backstroke
3:30 pm      50 meter Breaststroke                             Swimming…………..Sheridan Junior High School Pool
3:45 pm      100 meter IM Relay                                1:00 pm       100 meter Breaststroke
4:00 pm      500 meter Freestyle                               1:15 pm       50 meter Sidestroke
                                                               1:30 pm       100 meter Individual Medley
Other Events………..Holiday Inn                                   1:45 pm       25 meter Breaststroke
6:00 pm          Banquet Dinner, Awards and                    2:00 pm       50 meter Butterfly
                 Entertainment                                 2:15 pm       200 meter Freestyle
                                                               2:30 pm       100 meter Freestyle Relay (4 person)
                                                               2:45 pm       100 meter Butterfly
                                                               3:00 pm       25 meter Freestyle
Saturday, July 28, 2007                                        3:15 pm       200 meter Breaststroke
                                                               3:30 pm       25 meter Sidestroke
6:00 am – 4:30 pm   Check-in and packet pick-up, information   3:45 pm       100 meter Backstroke
                    and results, Sheridan Senior Center.       4:00 pm       Diving
                    Results also at the Sheridan County
                    YMCA.                                      Darts………………..Elk’s Club
                                                               1:30 pm      Singles
Road Race…………...Big Horn Women’s Club, Big Horn,
                Wyoming                                        Badminton………….Sheridan County YMCA
7:00 am………………5K Run / Walk                                     3:00 pm       Single
                                                               4:00 pm       Doubles
Softball……………….Sheridan College Softball Complex               5:00 pm       Mixed Doubles
8:00 am………………..Softball Tournament
                                                               Other Events
Tennis………………..Sheridan High School Tennis Courts               Dinner on your own
8:00 am       Singles
10:00 am      Doubles
12:00 noon    Mixed Doubles                                               Schedule of Noncompetitive Events
Track and Field……..Sheridan High School Track                  Wednesday, July 25, 2007
8:00 am           50 meter Dash                                6:45 pm             Wyoming Senior Olympics Board and Annual
8:15 am           400 meter Fun Walk                                               Membership Meeting at Sheridan Senior
9:00 am           1500 meter Race Walk                                             Center. Please use north door.
9:30 am           400 meter Race Walk                                              All Wyoming Seniors are Welcome!
9:30 am           Discus Throw
10:00 am          Frisbee Throw                                Thursday, July 26, 2007
                                                               11:30 am – 1:00 pm Lunch at the Sheridan Senior Center
10:00 am          400 meter Dash
10:30 am          High Jump                                    5:30 pm              Sheridan Senior Center, Parade of Athletes
11:00 am          Shot Put                                                          to Kendrick Park
11:00 am          1500 meter Run
11:30 am          Football Throw                               6:00 – 8:00 pm        Dinner and Entertainment in Kendrick Park

Disc Golf……….……Sheridan High School                            Friday, July 27, 2007
9:00 am        Singles                                         11:30 am - 1:00 pm    Lunch at the Sheridan Senior Center

                                                               6:00 pm               Banquet Dinner at the Holiday Inn
                                              2007 Wyoming Senior Olympics
                                                Official Registration Form
Please type or print clearly:                                                T-shirt Size (check your size)
For athletes that compete in more than one state Olympics, please
                                                                      Medium     Large       X-Large        XX Large
register using the same first name to help us serve you better.

Name:______________________________________                          Amateur Athletic Waiver and Release of Liability

                                                                    In consideration of being allowed to participate in any way in the
Address:____________________________________                        Wyoming Senior Olympics programs, its related events and
                                                                    activities. I, the undersigned, acknowledge, appreciate and agree
City:________________State:_______Zip:_________                     that:
                                                                    1. The risk of injury from the activities involved in the program is
Telephone Number:____________________________                       significant, including the potential for permanent paralysis and
                                                                    death, and while particular skills, equipment, and personal
                                                                    discipline may reduce this risk, the risk of serious injury does
E-mail Address (optional):______________________                    exist, and,
                                                                    2. I KNOWINGLY AND FREELY ASSUME ALL SUCH
Date of Birth*:___/____/____Age:____Gender:_____                    RISKS, both known and unknown, EVEN IF ARISING FROM
*A copy of your birth certificate or driver’s license               THE NEGLIGENCE OF THE RELEASES or others, and assume
                                                                    full responsibility for my participation; and,
must accompany your registration!
                                                                    3. I willingly agree to comply with the state and customary terms
Emergency Contact:                                                  and conditions for participation. If, however, I observe an
                                                                    unusual, significant hazards during my presence or participation, I
Name:_______________________,#______________                        will remove myself from participation and bring such to the
                                                                    Organization immediately, and
                                                                    4. I, for myself and on behalf of my heirs, assigns, personal
                       Registration                                 representatives and next of kin, HEREBY RELEASE,
        There is a $5.00 general registration fee per               INDEMNIFY AND HOLD HARMLESS, Sheridan County and
participant. There is also a $5.00 entry fee per person             the Wyoming Senior Olympics, their officers, agents and/or
for each event. All Registrations must be                           employees, other participants, sponsoring agencies, sponsors,
postmarked no later than July 12, 2007. Any                         advertisers and, if applicable, owners and lessors or premises used
                                                                    for the activity (“Releasees”). WITH RESPECT TO ANY AND
Registration postmarked after July 12th will be
                                                                    ALL INJURY, DISABILITY, DEATH, or loss or damage to
assessed a $10 late fee. No day of event registrations              person or property, WHETHER ARRISING FROM THE
will be accepted.                                                   NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the
        To register for an event, clearly check the box             fullest extent permitted by law.
to the left of the event. Please do not register for two
                                                                    I HAVE READ THIS RELEASE OF LIABILITY AND
events that are scheduled at the same time. Athletes
                                                                    ASSUMPTION OF RISK AGREEMENT, FULLY
must be present and ready to go at the scheduled time               UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE
of the event.                                                       GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND
                    Fees for Activities                             SIGN IT FREELY AND VOLUNTARILY WITHOUT AND
•Thursday Lunch Free of Charge (Circle One) yes / no                INDUCEMENT.
•Friday Lunch Free of charge (Circle One)         yes / no          Signature:___________________Date:___/____/ 2007
                   (Donations Welcome)
                                                                    Pertinent medical information (medical condition,
•Registration Fee, each participant:     $ 5                        special medication, allergies, and other information):
•$5.00 for each event: ____events x $5 = $______                    Please attach any information which is necessary to
•Thursday Evening Bar-B-Que $6 per person                           ensure your health and safety.
    No. of persons attending:____ x $6 = $______
•Friday Holiday Inn Banquet at $15                                  1st 300 Registrants will receive a free gym bag and a
    No. attending _____ x $15        =   $______                    Sheridan, WY, Wyoming Senior Olympics pin!
•Voluntary Donation / Contribution = $______
•Late Fee ($10 only after July 12)    =  $______                    Checks, Money Orders to:Wyoming Senior Olympics
                                                                    Send Registration to:   P. O. Box 937
              Total Amount Enclosed:                 $______                                Sheridan, WY 82801
                                     Wyoming Senior Olympics
                                              2007
                    Wyoming Senior Athletes of the Year Nomination

If you would like to nominate an individual for the Wyoming Senior Male Athlete of the Year and/or the
Wyoming Senior Female Athlete of the Year, please complete the form below. Nominees (1) must be
residents of Wyoming, (2) have participated in the Wyoming Senior Olympics and (3) not have received
the award previously. The nomination statement should be at least 150 words and may include
community service, awards or recognition received other than at the Senior Olympics and efforts to
promote senior health and fitness.

Senior Male Athlete of the Year Nominee: Name:_________________________________________
Address:______________________________________ Phone Number if known: (307)____________

I nominate this man because: _________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Senior Female Athlete of the Year Nominee: Name:_______________________________________
Address:________________________________________Phone Number if known; 307)____________

I nominate this lady because:____________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Please complete the Nomination form by July 19, 2007 and return to Jim Eggenberger, State
Coordinator, P. O. Box 937, Sheridan, WY 82801. Questions? Please call Jim at (307) 673-0000.
Please provide your name and phone number. Name:__________________ Phone: (307)___________
                               Wyoming Senior Olympics
                                          July 26-28, 2007
Sheridan, Wyoming is very proud to host the 2007 Wyoming Senior Olympic Games
July 26 – 28, 2007. We extend a hearty invitation to you to attend and to participate in the
Senior Olympic events. Individuals age 50 or older as of December 31, 2007 may participate in
activities that they are physically able to perform. There are no Wyoming residency
requirements to participate.

                                   Registration Instructions
To register, choose and mark your event(s) on the Events Registration Form and fill out
completely the Official Registration Form. Send a check or Money Order for the appropriate
fees. The deadline to enter must be postmarked no later than July 12, 2007. Registrations
postmarked after July 12 will be assessed a Late Fee of $10. Registration at the Olympics will
be taken July 25, 26, and 27th. No registration will be taken after 5:00 pm the day before
the event is scheduled.

Free gym bags and a 2007 Sheridan Wyoming Senior Olympics lapel pin will be given to the
first 300 registrants.

                              Registration and Information Center
All registrants should first check in at the Sheridan Senior Citizens Center (Senior Center) to
pick up registration packets, T-shirts, gym bag and pin. Throughout the event, the Senior
Center will serve as the registration and information headquarters. The Senior Center is located
at 211 Smith Street and the phone number is (307) 672-2240.

                         Additional Information and Contact Person
For additional information, refer to www.wyseniorolympics.com or call State Coordinator Jim
Eggenberger at (307) 673-0000.

                               Special Fees and Information
Bowling: The charge for bowling is $1.80 per line ($5.40 per event) at Cloud Peak Lanes. Pay
Cloud Peak Lanes the day of the events.

Golf: Greens fees will be $25 with cart rental and $18 without a cart, payable at the Kendrick
Municipal Golf Course Club House the morning of the event.

Skeet and Trap: Targets will be sold at $11 for 50 targets. 12 ga. and 20 ga. ammunition will
be available at $5 per box and a limited supply of 28 ga. and .410 ga. ammunition for $8 per
box (25 shells / box). Pay at the Sheridan County Sportsmen’s Clubhouse. Basic rules of
safety apply. Violation of safety rules will result in disqualification.




                                               1
                                     Age For Competition
Age bracket for all singles competition at the Wyoming Senior Olympics will be determined
by the athlete’s age as of December 31, 2007. Age bracket for all team competition will be
determined by the age of the youngest player as of December 31, 2007.

Athletes must provide accurate contact information, including mailing address, phone number
and a copy of your birth certificate or driver’s license must accompany your registration.

During the Sheridan Olympic Games, events will be held in ten age brackets. Age brackets are:
50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94, 95 and up.

                                            Medal Policy
Gold, silver and bronze medals will be awarded to the top three Wyoming participants in each
event, first. Any out of state participants placing in the top 3 of an event will then be awarded
the appropriate gold, silver or bronze medal. Medals will be awarded at the conclusion of each
event.

                              Who is Qualified to Participate
Anyone 50 years of age and older as of December 31, 2007 is qualified to participate. There is
no Wyoming residency requirement.

                                    Registration Confirmation
Once the participant’s registration form has been received and entered, athletes will receive a
confirmation letter. If any part of the registration is incomplete, athletes will receive
notification in the confirmation letter.

                                          Athlete Check In
The Wyoming Senior Olympic Athlete check in headquarters will be the Sheridan Senior
Citizens Center (Senior Center), located at 211 Smith Street. Athletes may pick up their
registration packets and T-shirts at this location. Please use the north door.

                                           Refunds
Refunds are to be requested in writing and will be assessed a $10 processing fee. Refunds will
be issued for the following reasons:
   • An event is canceled by the WSO Officials.
   • A medical reason with notification in writing, provided prior to the start of the Wyoming
       Senior Olympics, July 26, 2007.
   • No refunds will be issued after the completion of the Games, July 28, 2007.




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