2018 MN SENIOR GAMES INDIV. INDIVIDUAL REGISTRATION FORM

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2018 MN SENIOR GAMES INDIV. INDIVIDUAL REGISTRATION FORM *Please cmplete this frm (bth sides), sign the liability waiver and return t address belw with fee payment.

1 2018 MN SENIOR GAMES INDIV. INDIVIDUAL REGISTRATION FORM *Please cmplete this frm (bth sides), sign the liability waiver and return t address belw with fee payment. PAPER REGISTRATION MUST BE POSTMARKED BY: 7/30/2018 PERSONAL INFORMATION (Print carefully r paste address label) First Name: MI: Last Name: Gender: Male Female Address: City: State: Zip: Phne: Birth Date: / / Age (as f 12/31/2018) In Case f Emergency Cntact/Relatinship Phne Number: QUESTIONS 1. What size T-shirt wuld yu like? (shirts are unisex) S M L XL 2XL FEES (Please add yur ttal amunt in bx) Registratin Fee - $ $ Paper Registratin Administrative & Prcessing Fee $ 7.00 OPTIONAL ADDITIONAL FEES Additinal Sprts - $5.00 (First 5 sprts are included in general fee) $ Extra T-Shirt - $10.00 each: S M L XL 2XL $ Dnatin t Minnesta Senir Games $ Bwling Fee - Additinal Fee $12.00 t be paid n site Glf Fee - Additinal Fee $35.00 t be paid n site TOTAL: $ *PAYMENT (Checks payable t VISIT MANKATO) Send Payment t: Mankat Sprts Cmmissin 12 Civic Center Drive Suite #1645, Mankat, MN, Cntact Us: Phne: (507) jbaumann@visitmankatmn.cm Website:

2 2018 MN SENIOR GAMES INDIV. INDIVIDUAL REGISTRATION FORM Athlete Name: ARCHERY Cmpund Fingers Barebw Recurve Recurve Cmpund Release Barebw Cmpund BADMINTON Singles Dubles Partner: Year Brn: Mixed Dubles Partner: Year Brn: BASKETBALL 3 n 3 (half curt) Free Thrw Team Name: Captain s Name: BOWLING Singles Dubles Mixed Dubles Partner: Year Brn: Average: CYCLING 5K Time Trial 20K Rad Race DISC GOLF GOLF (18 hle) HORSESHOES 10K Time Trial 40K Rad Race ROAD RACE 5K 10K SHUFFLEBOARD Singles Dubles Partner: Year Brn: SOFTBALL Men Wmen Team Name: Captain s Name: SWIMMING (limited t 6 events) 50 Breast 100 Breast 200 Breast 50 Back 100 Back 200 Back 50 Free 100 Free 200 Free 50 Butterfly 100 Butterfly 500 Free 100 IM 200 IM TABLE TENNIS Singles: Dubles: Partner: Year Brn: Mixed Dubles Partner: Year Brn: TENNIS Singles: Dubles: Partner: Year Brn: Mixed Dubles Partner: Year Brn: PICKLEBALL Singles Dubles Partner: Year Brn: Mixed Dubles Partner: Year Brn: POWER WALK 1500m 5000m RACE WALK 1500m 5000m 5000m nn-tech walk RACQUETBALL Singles Dubles Partner: Year Brn: Mixed Dubles Partner: Year Brn: TRACK AND FIELD 50 meter dash 100 meter dash 200 meter dash 400 meter dash 800 meter run 1500 meter run Discus High Jump Javelin Lng Jump Ple Vault Sht Put Triple Jump VOLLEYBALL Men Wmen Team Name: Captain s Name: Cntact Us: Phne: (507) jbaumann@visitmankatmn.cm Website:

3 2018 MN SENIOR GAMES TEAM TEAM REGISTRATION FORM PAPER EGISTRATION MUST BE POSTMARKED BY: 7/30/2018 *T be cmpleted and submitted by Team Captain alng with individual registratin blanks and checks. TEAM INFORMATION (Print carefully r paste address label) Sprt: Team Name: Captain s Name: Age Divisin: Phne: Captain s Address: TEAM REGISTRATION PROCEDURE: Team captains are respnsible fr submitting the team fee with rster. Team members will receive an MN Senir Games T-Shirt fr playing a team sprt. If a team player wishes t participate in ther individual events they must register fr the event as an individual and will receive a T-shirt fr that event. If yu wish t purchase additinal T-Shirts fr yur team members the cst is $10.00 per shirt. PLAYER/T-SHIRT SIZE ADDRESS PHONE DATE OF BIRTH TEAM FEES: Basketball, Sftball, Vlleyball - N lnger have team fees, every player must sign up with an individual registratin t participate in a team sprt. Paper Registratin Administrative & Prcessing Fee: $7.00 Additinal T-Shirt - $10.00 each: S M L XL 2XL = TOTAL $ PAYMENT (Checks payable t VISIT MANKATO) Send Payment t: Mankat Sprts Cmmissin - 12 Civic Center Drive Suite #1645, Mankat, MN Cntact Us: Phne: (507) jbaumann@visitmankatmn.cm Website:

4 2018 MINNESOTA SENIOR GAMES WAIVER In cnsideratin f my participatin in the 2018 Minnesta Senir Games ( The Games ) - hsted by the Mankat Sprts Cmmissin, I agree t assume the risks incidental t such participatin (which include, but are nt limited t, prperty damage, bdily injury and death) and n my wn behalf and n behalf f my heirs, executrs and administratrs RELEASE AND FOREVER DISCHARGE the "released parties" f and frm all liabilities, claims, actins, damages, csts r expenses f any nature arising ut f r in any way cnnected with my participatin in The Games and further agree t indemnify and hld each f the released parties harmless against any and all such liabilities, claims, actins, damages, csts r expenses including, but nt limited t, all attrneys fees and disbursements. Participant understands and agrees that activities assciated with The Games may be dangerus and that Mankat Sprts Cmmissin cannt guarantee the safety f the Participant. Any activities Participant may take part in, whether as a cmpnent f The Games r separate frm it, will be cnsidered t have been undertaken with Participant s apprval and understanding f any and all risks invlved. The "released parties" are Mankat Sprts Cmmissin, Visit Mankat, related and affiliated cmpanies, and the trustees, fficers, directrs, emplyees, faculty, students, agents, representatives, vlunteers, spnsrs, and venues, and the successrs and assigns f each f the freging entities. I understand that this release, indemnity and hld harmless agreement includes any claims based n negligence, actin, inactin r fault f any f the released parties and cvers bdily injury (including death) and prperty damage related t my participatin in The Games, whether suffered by me befre, during r after such participatin. This release agreement shall be cnstrued t be as cmprehensive as is allwed by law, as severable, the invalidity f any prtin f which shall nt affect any ther prtin; and shall nt establish a legal r ther relatinship between r amng the persns released by this agreement. I als agree t hld harmless and t indemnify the released parties frm and against all claims, actins, damages and expenses, including but nt limited t reasnable attrney s fees fr any alleged injury and/r death t any persn r damage t any prperty arising, r alleged t have arisen ut f my negligent, reckless r intentinal acts r failure t act by me r my heirs, successrs r assigns. DECLARATION OF FITNESS AND AUTHORIZATION FOR MEDICAL TREATMENT: I declare that I am physically fit and have the skill level required t participate in The Games and in my particular event(s). I further authrize Mankat Sprts Cmmissin and their agents t prvide me with medical treatment (including transprtatin t receive medical treatment) at my cst if the need arises. GRANT OF RIGHTS: I further grant Mankat Sprts Cmmissin, their spnsrs and marketing partners, as well as the media and thers t whm the Mankat Sprts Cmmissin grant such rights, the right t phtgraph, videtape and/r therwise recrd me and my perfrmance and further t use my name, face, likeness, vice, appearance, and persnal data fr any purpse including, but nt limited t, exhibitins, publicity, advertising and prmtinal materials withut reservatin, limitatin r cmpensatin. Said parties are, hwever, under n bligatin t exercise the rights set frth in this paragraph. CANCELLATION OF GAMES: Participant understands that Mankat Sprts Cmmissin reserves the right t cancel r mdify The Games fr any reasn. Cntact Us: Phne: (507) jbaumann@visitmankatmn.cm Website:

5 2018 MINNESOTA SENIOR GAMES WAIVER CHOICE OF LAW AND CHOICE OF FORUM: This agreement shall be gverned by the internal laws f the State f Minnesta withut regard t cnflicts f laws principles, and any legal actin relating t r arising ut f this Agreement shall be cmmenced and maintained in the state r federal curts lcated in Minnesta. The parties heret cnsent t the exclusive jurisdictin f such curts and t service f prcess utside f the State f Minnesta, and participant waives all defenses f lack f persnal jurisdictin, venue and frum nn cnveniens. The language f all parts f this release shall in all cases be cnstrued as a whle, accrding t its fair meaning, and nt strictly fr r against any party. This release is the nly, sle, entire, and cmplete agreement f the parties relating in any way t the subject matter heref. N statements, prmises, r representatins have been made by any party t any ther, r relied upn, and n cnsideratin has been ffered r prmised, ther than as may be expressly prvided herein. This release supersedes any earlier written r ral understandings r agreements between the parties. Participant's signature is required t cmplete the registratin prcess and further indicates that the infrmatin n this frm is accurate. Alteratin f the frm is nt permitted. Participant acknwledges that she/he has read this release and that she/he understands its meaning and effect. Print Name: Sign Name: Date: Date: Cntact Us: Phne: (507) jbaumann@visitmankatmn.cm Website:

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o o o o o o o o 6-34 CR 6/18 6-34 CR 6/18 6-34 CR 6/18 6-34 CR 6/18 6-34 CR 6/18 6-34 CR 6/18 6-34 CR 6/18 Schedule f Each Event Schedule f Each Event 6-34 CR 6/18 6-34 CR 6/18 This frm must be cmpleted by anyne emplyed