Senior Olympics 2013 Entry Form by Jewish Community Center

For s ete l h t A 50+

May 23-28, 2013

Fitness for a Lifetime! Registration Deadlines: April 15 (Early) & May 13 (Final) Online Registration Available

2013 Entry Form 1

Get in the games!

2 Senior Olympics

About the St. Louis Senior Olympics The St. Louis Senior Olympics is an Olympic-style sporting event for men and women age 50 and better. This yearâ&#x20AC;&#x2122;s schedule includes more than 90 individual, partner and team events. Our long time success is due to the incredible support we receive from corporate sponsors, community partners, long time participants and dedicated volunteers who share in the excitement and camaraderie that is felt during the Games! Enclosed you will find the Official Entry Form, Team Entry Form & Roster, Volunteer Sign-Up, and Schedules. The Senior Olympics is a chance for the entire community to come together to celebrate the accomplishments of OUR Seniors! We are looking forward to having you join us in 2013.

2013 Events Accuracy Plug Casting Art Competition Badminton Baseball Homerun Derby Basketball 3 on 3 Basketball Around the World Basketball Free Throw Billiards Bocce Bowling BulletBall Cycling Dart Throw Football Kick Football Punt Football Throw Accuracy Football Throw Distance Frisbee Toss Golf 9-Hole Golf 18-Hole

Handball Horseshoes Racquetball Shuffleboard Soccer 7 v 7 Soccer Kick Accuracy Soccer Kick Distance Softball Homerun Derby Softball Throw Accuracy Softball Throw Distance Squash Swimming Table Tennis Tap Dance Tennis Track & Field Volleyball Washer Toss Water Volleyball Weightlifting

2013 Entry Form 3

2013 Sponsors

for

Support the St. Louis Senior Olympics

In an effort to maintain the excellence of the St. Louis Senior Olympics, we created the “Friends of the St. Louis Senior Olympics.” We are asking you, as our Friend, to join this campaign to help maintain the viability of the St. Louis Senior Olympics. Friends’ contributions can be made when you register online or on page 11. Thank you in advance for your help and continued support of the St. Louis Senior Olympics.

4 Senior Olympics

Online Registration Instructions How to Register Online ATHLETE (Singles and Doubles events) 1) Log into the registration system. A) https://www.nsga.hangastar.com/registration NOTE: You can retrieve your account number by contacting the St. Louis Senior Olympics office (314-442-3279 / solympics@jccstl.org) or click on the “Forgot Account Number” button and your number will be sent to the email on file. 2) Activate online account (one time) and follow instructions. 3) Confirm information is correct 4) Click on the “Games Registration” tab. 5) Click “Register Now” to the left of “2013 St. Louis Senior Olympics” 6) Scroll down and click ‘Register as a guest, athlete and/or request to be on a team’. 7) Follow the instructions on each page to register. 8) Complete your registration by paying the individual registration fee. HELPFUL TIPS: DOUBLES: If your partner is NOT listed on the partner selection page, this is NOT a problem – it just means your partner has not registered yet. Just select “I could not find my partner in the provided list” and click “Next”. If your partner has registered, they will be listed. Click on your partners name in the list and then click “Next”. DOUBLES PARTNER CHANGE: If you need to change your partner, click “Change Partner?” on the event selection page. Type in the information about your new partner and the system will search to see if they are an acceptable partner change. TEAM (3 on 3 Basketball, 7 v 7 Soccer, Volleyball, Water Volleyball) Please keep in mind ONLY the team captain can register the team. Each team can only have ONE CAPTAIN. If any players need to be ADDED to the team, those players must log into their own account on the registration system and make a TEAM REQUEST to be on the team (instructions below on how to do this). A team request can only be made AFTER the team is already registered. To Register The Team (Team Captain Only): 1) Log into the registration system. A) https://www.nsga.hangastar.com/registration NOTE: You can retrieve your account number by contacting the St. Louis Senior Olympics office (314-442-3279 / solympics@jccstl.org) or click on the “Forgot Account Number” button and your number will be sent to the email on file. 2) Activate online account (one time) and follow instructions. 3) Confirm information is correct 4) Click on the “Games Registration” tab. 5) Click “Register Now” to the left of “2013 St. Louis Senior Olympics” 6) Scroll down and click ‘Register your team for a team sport’. 7) Follow the prompts to register your team. 8) Complete your registration by paying the registration fee. ONCE REGISTERED, HOW TO CONFIRM/REMOVE PLAYERS (TEAM CAPTAIN ONLY): Once you register the team, you need to confirm or remove each player and finalize the team. Do this by going to the “Registration Status” tab and follow the instructions. Please keep in mind any qualified player can make a request to be on your team, so you should review your roster carefully. ADDING A QUALIFIED TEAM MEMBER: Each player you want to add to your team must log onto their registration system account and make a “team request” for your team. A team request cannot be made until the captain has registered the team. For a player to make a team request: 1) Log into the registration system. 2) https://www.nsga.hangastar.com/registration NOTE: You can retrieve your account number by contacting the St. Louis Senior Olympics office (314-442-3279 / solympics@jccstl.org) or click on the “Forgot Account Number” button and your number will be sent to the email on file. 3) Activate online account (one time) and follow instructions. 4) Confirm information is correct 5) Click on the “Games Registration” tab. 6) Click “Register Now” to the left of “2013 St. Louis Senior Olympics” 7) Scroll down and click ‘Register as a guest, athlete and/or request to be on a team’. 8) Follow the prompts to make a team request for your team. NOTE: The team will only show up in the box if the captain has already registered the team. Once you complete your team request, the captain will see you on the roster and can confirm or decline you. You will receive email notification once the captain confirms or declines you. 2013 Entry Form 5

Registration Deadlines & Fees Registration Deadlines Early Registration Deadline — Monday, April 15 Final Registration Deadline — Monday, May 13 St. Louis Senior Olympics is not responsible for delays involving the United States Postal Service. Send or deliver entry forms to: Jewish Community Center, ATTN: St. Louis Senior Olympics, 2 Millstone Campus Dr., St. Louis, MO 63146.

Liability Waiver MUST be signed and turned in with the Official Entry Form.

Registration Fees General Registration A NON-REFUNDABLE and NON-TRANSFERABLE General Registration Fee must be included with the entry form. Checks should be made payable to “St. Louis Senior Olympics”. The fee is $40 for entries received on or before April 15 and $45 after April 15. Both partners in doubles events must register and pay indicated fees. Team event participants and Tap Dancers see fees below. Bowling and Golf require an additional facility fee, see below. Team Events Participants: 3 on 3 Basketball, 7 v 7 Soccer, Volleyball and Water Volleyball All players on a team roster MUST complete the Official Entry Form and include the team event participant fee of $25. Any team player interested in participating in other events must pay the full General Registration Fee of $40 or $45. • Team captains are responsible for turning in Team Entry Form and Roster (Page 10) by Monday, May 13. Team entry forms will not be processed unless all team members have submitted their entry form and payments. The Senior Olympics office encourages that they are submitted together. Tap Exhibition/ Masters Class Participants Tap dancers who participate in ONLY the Exhibition and Masters Class may register for $28. Those dancers interested in participating in other events must pay the full General Registration Fee of $40 or $45. The Tap Master’s Classes will be held on Thursday, April 25 from 9am – 1pm. The Tap Exhibition, dedicated to the memory of LaVerne Strotheide, will be held on Thursday, May 23 at 1:30pm. All tap programming will be held at the JCC in Creve Coeur. Tap Masters Class registration deadline is Thursday, April 4.

Please contact the Senior Olympics office for scholarship information.

Additional Facility Fees Bowling Requires an additional FACILITY FEE of $8 for each session participant selects except the 3-person Baker Team bowling session, which is only $3 (Bowling shoes available at no additional cost). This fee is NON-REFUNDABLE after May 13. Golf Requires an additional FACILITY FEE. (Fee includes greens fee for 18 holes and electric cart. All golfers must ride). This fee is NON-REFUNDABLE after May 13. 9-Hole - $23 at Creve Coeur Golf Course 18-Hole - $35 at the Norman K. Probstein Golf Course in Forest Park

6 Senior Olympics

Important Information St. Louis Senior Olympics Office Jewish Community Center Staenberg Family Complex 2 Millstone Campus Drive St. Louis, MO 63146

Phone: Fax: Email: Website: Registration Site:

(314) 442-3279 (314) 442-3279 solympics@jccstl.org stlouisseniorolympics.org nsga.hangastar.com/registration

Eligibility Minimum Age Requirements

Individual and Tournament (non-team) Events – Participant must turn 50 by May 23, 2013 Team Events – Participant must turn 50 by December 31, 2013

Age Divisions

Except as noted below, there will be 9 age divisions for both men and women in each athletic competition. 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Individual Events will be 5 year divisions when 3 or more are competing. In events with less than 3 competitors divisions may be combined. All participants must compete in their own age group except as noted below. At the discretion of the Event Director, other age divisions may be determined. Team Events 50-59, 60-69, and 70+ Doubles and Partner Events the age of the younger partner determines the age division.

Senior “Olympic Trial” Day

If you are curious about an event or want to experience a new sport, here’s your chance. Sunday, April 7 4 – 6pm The Staenberg Family Complex will host the first ever Senior Olympics training day. Bring a friend and try a new sport, learn the rules, scoring, techniques and see demonstrations on several of this year’s events. You can use this to help you decide to participate as a first-time athlete or to try a new event. Light snacks will be provided. Be sure to register for the Olympic Trial Day on page 15.

Packet Pick-Up

Packet Pick-Up will be available during the Tap Exhibition (Thursday, May 23 1:30 – 4pm). Participants can check in at the Jewish Community Center in Creve Coeur and receive an age identification wristband to participate in the events. Participants may also check-in at the Information Desk at the Jewish Community Center in Creve Coeur: Friday, May 24 – Monday, May 27 (7am – 4pm).

2013 Entry Form 7

Important Information - cont. Senior Olympics Pool Party & BBQ

NEW!

Sunday, May 26 6-8pm After the competition is underway, come back to the Staenberg Family Complex to eat and relax poolside with all of the Senior Olympic athletes and their families. Traditionally the Opening Ceremonies, the Pool Party will include the torch lighting, commencement speeches and presentation of the Walter “Doc” Eberhardt and Helen Stephens Memorial Awards. Cost of the Pool Party is $10 per person and you can register on page 11.

Vendors & Health Screenings

Throughout the Games, local vendors, hospitals and health organizations will be onsite offering services and free product samples for Senior Olympic athletes at pre-determined times when events are taking place at each location. The venues include the Staenberg Family Complex (Creve Coeur); Marilyn Fox Building (Chesterfield); and Gay Field.

Volunteers

Volunteer opportunities are listed on pages 17-18. Please contact the Senior Olympics office for group volunteer opportunities.

Tournaments

The following Tournaments will be drawn on site: BADMINTON, BILLIARDS, BOCCE, BULLETBALL, HANDBALL, HORSESHOES, RACQUETBALL, SHUFFLEBOARD, SQUASH, TABLE TENNIS AND WASHER TOSS. List of registered participants in each division will be available at the JCC several days prior to the start of the Games. All participants must check in with the event director approximately 10–15 minutes prior to the start time.

Awards

Medals will be awarded to the 1st, 2nd and 3rd place finalists in each age division of each event. Ribbons for 4th, 5th and 6th place will be awarded according to participant numbers. See published rules for each event for information concerning ties. In bowling and golf (18-Hole) awards will be given for both scratch and handicap events but a participant can only win one of these awards per event. In bowling and golf (18-Hole), the award will be made first to the top three scratch places, then to the top three handicap places, then to the 4th, 5th and 6th scratch places, then the 4th, 5th and 6th handicap places. The 9-Hole tournament is scratch only. Golfers must bring a current USGA handicap card to the course to compete in handicap division.

8 Senior Olympics

Event Specific Instructions Accuracy Plug Casting Open-faced or closed-faced reels. A limited number of eye guards and spin casting reels will be available for loan.

Handball, Racquetball and Squash Racquets, gloves, eye guards with impact resistant polycarbonate lenses or shatterproof glasses are mandatory for all indoor court events.

Art Competition Participants in the Art Competition will receive a copy of the Art Competition Rules containing updated requirements, show information and drop-off/ pick-up times after registration.

Swimming 2013 USMS rules will be followed but is a non-USMS sanctioned event. Pool available for warm-ups ½ hour prior to the first scheduled event. The 2013 swimming events will take place at the Jewish Community Center Marilyn Fox Building in Chesterfield. Directions will be listed in the Spring Newsletter.

Billiards Billiards rules will be in accordance with the B.C.A. (Billiards Congress of America).

Tap Dance The Tap Master’s Classes will be held on Thursday, April 25 from 9am – 1pm. Bowling The Tap Exhibition, dedicated to the memory of LaVerne Strotheide, will be Bowling balls and shoes available at Olivette Lanes if not provided by held on Thursday, May 23 at 1:30pm. participant. Participants must wear bowling shoes. Bowling will follow USBC All tap programming will be held at the JCC in Creve Coeur. rules but is a non-USBC sanctioned event. If there is no average, last years Tap Masters Class registration deadline is Thursday, April 4. Senior Olympics average will be used. If you do not have a Senior Olympics average, one will be assigned as follows: Men, 140; women, 125; handicap Team Events All players on a team roster MUST complete the Official Entry Form and will be 80% from 200. It shall be the bowler’s responsibility to verify the include the team event participant fee of $25. Any team player interested in average in the handicap portion of the tournament. Failure to use proper average will result in disqualification. Correction of average can be made at participating in other events must pay the full General Registration Fee of $40 or $45. Team captains are responsible for completing the Team Entry “Check-in” at the bowling lanes. Form and Roster. (page 10) BulletBall Tennis BulletBall is a new ‘all-inclusive’ sport game that allows everyone to participate regardless of age, gender, or physical disability. It is played atop Tennis will follow USTA rules. Participants may enter both singles and a table on a court surface designed for challenging play by two people. doubles tournaments, but must be available to play multiple matches per BulletBall can be played while standing or sitting; the choice is up to day. Failure to show up for a scheduled match will result in disqualification each individual player. The direct contact, speed, and accuracy needed in for 2013 and lose your right to play in the following year’s tournament. propelling a ball with the forearms and/or hands make for a spirited contest Track & Field both mentally and physically. Check it out at inclusionsports.com. Track and Field is governed by USATF rules. Cycling 1k = 1 kilogram = 2.2 pounds; 100g = 100 grams = 3.5 ounces ANSI approved helmets are required. Non-motorized multi-speed (or less) Discus: 1k for women 50-74 and men 60+, .75 for women 75+, bicycles with no reduction resistance devices. Fixed gear bicycles must have 1.5k for men 50-59 brakes. The 2013 Missouri State Time Trial Championship will be held Javelin: 400g for women 60+ and men 80+, 500g for women 50-59 and on Saturday, August 10 in Jefferson City, MO. men 70-79, 600g for men 60-69, 700g for men 50-59 Shot Put: 2k for women 75+, 3k for women 50-74 and men 80+, Doubles/ Partner Events 4k for men 70-79, 5k for men 60-69, 6k for men 50-59 Both partners must register and pay fees. Participants may not duplicate Pole Vault: Participants need to be in good physical condition and will need entry in any one event with more than one partner. No assignments will be to supply their own pole made by the St. Louis Senior Olympics office. Volleyball/Water Volleyball Golf Co-ed Volleyball team rules require minimum of three (3) women on court or Participant must provide clubs and balls for play for the 9-Hole and 18-Hole in pool at all times. Tournaments. (Also See Facility Fees). The golf handicap competition is limited to those who bring a current USGA handicap card to the event. The Weightlifting scratch competition is open to all. Places will be determined by a ratio of body weight to weight lifted. 9-Hole: All Women and Men 70+ will tee off on front (red) tees. Men 50-69 will tee off on back (blue) tees. 18-Hole: All Women and Men 80+ will tee off on front (silver) tees. Men 65-79 will tee off on middle (blue) tees. Men 50-64 will tee off on back (yellow) tees. Dogwood and Hawthorne courses will be used for 18-Hole Tournament.

2013 Entry Form 9

2013 St. Louis Senior Olympics

Team Entry Form & Roster •

Team captains are responsible for completing and returning this form by Monday, May 13.

•

All players on a team roster MUST complete the Official Entry Form and include the team event participant fee of $25. Any team player interested in participating in other events must pay the full General Registration Fee of $40 or $45.

•

Team entry forms will not be processed unless all team members have submitted their entry form and payments. The Senior Olympics office encourages that they are submitted together.

Team Events 3 on 3 Basketball o Men: Sun., 12pm o Women: Sun., 12pm

7 v 7 Soccer o Men: Sat., 9am o Women: Sat., 9am

Volleyball o Men: Sun., 1pm o Women: Sat., 5pm o Co-Ed: Mon., 8am

Water Volleyball o Co-Ed 50-64: Fri., 2:30pm o Co-Ed 65-74: Fri., 1pm o Co-Ed 75+: Fri., 9am

Team Information Team Name________________________________________________ Team Captain’s Name______________________________________ Phone # (

)___________________________________________ Alt. Phone # (

)_ ____________________________________

E-mail Address ___________________________________________________________________________________________________

Team Roster (Please Print First and Last Names) 1________________________________________________________ 11____________________________________________________ 2________________________________________________________ 12____________________________________________________ 3________________________________________________________ 13____________________________________________________ 4________________________________________________________ 14____________________________________________________ 5________________________________________________________ 15____________________________________________________ 6________________________________________________________ 16____________________________________________________ 7________________________________________________________ 17____________________________________________________ 8________________________________________________________ 18____________________________________________________ 9________________________________________________________ 19____________________________________________________ 10_______________________________________________________ 20____________________________________________________

Team Event Venues (Directions will be provided in Spring Newsletter)

3 on 3 Basketball – Jewish Community Center in Chesterfield

7 v 7 Soccer Tournament – Tony Glavin Soccer Complex

Volleyball – Jewish Community Center in Creve Coeur

Water Volleyball – Lutheran Senior Services at Laclede Groves

10 Senior Olympics

2013 St. Louis Senior Olympics

Official Entry Form OFFICE USE ONLY: Entry # o Art

o Friend

Events

$ Received

o Golf

o Team

o Tap

Pmt. Source

o Vol

Friend

o Partner

Participant Information Last Name______________________________________________ First Name______________________________________ MI_________ Mailing Address___________________________________________________________________________________________________ Address

Phone # (

City

)________________________________________ Alt. Phone # (

State

Zip

)_________________________________________

Gender o Male o Female Birthdate________________________________________________________ Age______________________ As of May 23, 2013

E-mail Address_ __________________________________________________________________________________________________

Emergency Contact Name_ ____________________________________________________________________________ Phone #_______________________ Relationship______________________________________________________________________________________________________ (Optional) At the request of our funders please check one of the descriptions below corresponding to the ethnic group with which you identify. o African American o Asian o Bi/Multiracial o Caucasian o Hispanic/Latino o Native American/Alaskan Native o Other

Participant Specifics I participated in the 2012 St. Louis Games

o Yes

o No

I am a new participant:

o Yes

o No

T-Shirt Size:

o Small

If yes, how did you hear about the Games?______________________________

o Medium

o Large

Registration and Facility Fees

o X-Large

o XX-Large

All Fees are Non-Refundable and Non-Transferable.

Registration Fees General Registration $40 if registered by Monday, April 15 $45 if registered after Monday, April 15

Team Only Tap Only

Facility Fees Bowling Golf 9-Hole Golf 18-Hole Pool Party & BBQ - NEW!

$_____________________

$25 for Basketball, Soccer, Volleyball or Water Volleyball. No other events. $28 for Tap Exhibition/ Masters Class. No other events. $8 for each event selected, $3 each for 3 Person Baker $23 (includes greens fee and cart) $35 (includes greens fee and cart) $10 per person # of people attending ______

Friends of the St. Louis Senior Olympics (tax deductible contribution)

o XXX-Large

$_____________________ $_____________________ $_____________________ $_ ___________________ $_____________________

TOTAL AMOUNT ENCLOSED

$_____________________

Payment Information

Checks payable to: St. Louis Senior Olympics Send to: Jewish Community Center, ATTN: St. Louis Senior Olympics, 2 Millstone Campus Drive, St. Louis, MO 63146 We cannot process registration unless the waiver is signed and fees are included.

Team Entry Forms cannot be processed until all team members have submitted their entry form and payments. Credit Card #________________________________________________ Exp. Date_____________________________ *Name as it appears on credit card____________________________________________________________________ *Billing address (if different from above)________________________________________________________________ Signature_ _____________________________________________________________________________________ 2013 Entry Form 11

Official Entry Form

Tournament & Team Events THE FOLLOWING TOURNAMENTS WILL BE DRAWN ON SITE. BADMINTON, BILLIARDS, BOCCE, BULLETBALL, HANDBALL, HORSESHOES, RACQUETBALL, SHUFFLEBOARD, SQUASH, TABLE TENNIS AND WASHER TOSS. List of registered participants in each division will be available at the JCC several days prior to the start of the Games. All participants must check in with the event director approximately 10 – 15 minutes prior to the start time.

One Day Tournaments

The following tournaments are completed in one day. Participants MUST be available to play until eliminated. Times listed are when the event begins – not necessarily your first match. Badminton

o Badminton Singles – (Men: Sat., 8am) (Women: Sat., 11am) o Badminton Doubles – (Sat., 1pm) o Badminton Mixed Doubles – (Sat., 3pm)

Partner’s Name & DOB____________________________________ Partner’s Name & DOB____________________________________

Billiards

o Billiards – Eight Ball – (70+: Fri., 10am) (50-69:

Fri., 11am)

Bocce

o Bocce – (Men 70+: Sun., 9am) (Men 50-69: Sun., 10am) (Women 50-64: Sun., 11:30am) (Women 65+: Sun., 1pm) BulletBall

o BulletBall – (Sat., 9:00 am)

Handball

o Handball Singles – (Mon., 8:30am) o Handball Open Doubles – (Mon., 1:15pm)

Partner’s Name & DOB____________________________________

Horseshoes

o Horseshoes Singles – (65-74: Sat., 12pm) (50-64: Sun., 12pm) (75+: Sun., 2pm) o Horseshoes Open Doubles – (Mon., 1pm) Partner’s Name & DOB____________________________________ Racquetball

o Racquetball Singles – (Sun., 8:30am) o Racquetball Open Doubles – (Sun., 2:15pm)

Partner’s Name & DOB____________________________________

Shuffleboard

o Shuffleboard Singles (Men 65-74: Sat., 10am) (Women 65-74: Sat., 2pm) (Men 50-64: Mon., 9am) (Women 50-64: Mon., 10:30am) (75+: Mon., 12pm) o Shuffleboard Open Doubles – (65+: Sun., 12pm) (50-64: Sun., 2pm)

Partner’s Name & DOB____________________________________

Squash

o Squash Singles – (Sun., 1:15pm) Table Tennis

o Table Tennis Singles – (Women: Sat., 8am) (Men 50-59: Sat., 12pm) (Men 60+: Sat., 1pm) o Table Tennis Doubles – (Women: Sat., 10am) (Men: Sat., 3pm) Partner’s Name & DOB____________________________________ o Table Tennis Mixed Doubles – (Sat., 3pm) Partner’s Name & DOB____________________________________

Washer Toss

o Washer Toss – (Women 50-64: Sun., 9am) (Women 65+: Sun., 11am) (Men 65+: Sun., 1pm) (Men 50-64: Sun., 2pm) 12 Senior Olympics

Official Entry Form

Tournament & Team Events (continued) Lynn Imergoot Memorial Tennis Tournament

Participants may enter both singles and doubles events and must be prepared to play from their first match until they are eliminated. Play is limited to no more than three matches in one day. Failure to show up for a scheduled match will result in disqualification for 2013 and lose your right to play in the following year’s tournament.

o Tennis Singles – Sat/Sun format to be determined based on entries. Best 2 of 3, match tie break for 3rd set o Tennis Doubles – Sat/Sun format to be determined based on entries. Best 2 of 3, match tie break for 3rd set

Partner’s Name & DOB_______________________________________________

*Matches may be played Friday after 4pm if necessary*

Team Events

Team entry forms cannot be processed unless all team members have submitted their entry form and payments. The Senior Olympics office recommends that they are submitted together.

o 3 on 3 Basketball – (Sun., 12pm) Captain & Team Name_______________________________________________ o 7 v 7 Soccer Tournament – (Sat., 9am) Captain & Team Name_______________________________________________ o Men’s Volleyball – (Sun., 1pm) Captain & Team Name_______________________________________________ o Women’s Volleyball – (Sat., 5pm) Captain & Team Name_______________________________________________ o Co-Ed Volleyball – (Mon., 8am) Captain & Team Name_______________________________________________ o Co-Ed Water Volleyball – (75+; Fri., 9am, 65-74; Fri., 1pm, 50-64; Fri., 2:30pm) Captain & Team Name_______________________________________________

For office use only _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ 2013 Entry Form 13

Official Entry Form

Individual Events In individual events with no end time, participants must report at the designated starting time. All events with a start and end time, participants may report and complete the event during the time frame allotted. These are approximate starting times; please arrive 10-15 minutes prior to the start of your event. Accuracy Plug Casting o Accuracy Plug Casting, 3/8 and 5/8 oz. – (Mon., 9am – 12pm) Art Competition Work must be ready for exhibition. All painting/drawing/photography must be framed and securely wired for hanging. Rules containing updated requirements, show information and drop-off/ pick-up times will be mailed after registration. o Ceramics o Collage o Drawing o Glass o Jewelry o Painting o Photography o Textiles Title of Art Work___________________________________________________________________________________________________ Baseball Homerun Derby o Baseball Homerun Derby – (Sun., 11am – 1pm) Basketball o Basketball Around the World – (Sun., 8:30 – 9:30am)

o Basketball Free Throw – (Sun., 9:30am – 10:30am)

Bowling (Facility Fees: $8 for each event selected, $3 per participant for 3-Person Baker) o Bowling Singles (Sat., 3pm or Sun., 7pm) $8 Select One: o Sat., 3pm o Sun., 7pm o Bowling 3-Person Baker Team – (Mon., 9am) $3

Partner’s Name & DOB 1____________________________________

Partner’s Name & DOB 2____________________________________

o Bowling Mixed Doubles – (Mon., 12:30pm) $8

Partner’s Name & DOB_ ____________________________________

o Bowling Doubles – (Sun., 3pm) $8

Partner’s Name & DOB_ ____________________________________

o Bowling 4-Person Teams – (Sat., 7pm) $8

Partner’s Name & DOB 1____________________________________

Partner’s Name & DOB 2____________________________________

Partner’s Name & DOB 3____________________________________

You will not be registered for partner/team events without listing all participants

Cycling o 9 miles (Sat., 8am) o 5 miles (Sat., 10:30am) o 5 kilometers (Sat., 11:30am) o 1 mile (Sat., 12:30pm) o Missouri State Time Trial Championship – (Saturday, August 10 - Jefferson City, MO) (50-59: 40K) (60+: 20K) Dart Throw o Dart Throw – (Sat., 11am – 2pm) Football o Football Punt – (Sat., 9 – 11am) o Football Kick – (Sat., 11am – 1pm) o Football Throw, Accuracy – (Mon., 9 – 10:30am) o Football Throw, Distance – (Mon., 9 – 10:30am) Frisbee o Frisbee Toss, Distance – (Sat., 3 – 5pm)

14 Senior Olympics

o ¼ mile (Sat., 1:15pm)

Official Entry Form

Individual Events (continued) Golf (Facility Fees: $23 for Golf 9-Hole, $35 for Golf 18-Hole) o Golf 9-Hole – Creve Coeur Golf Course – (Fri., 8am) $23 o Golf 18-Hole – Normal K. Probstein Golf Course in Forest Park – (Tue., 7:30am) $35 Golf Foursome (optional)

1________________________________________________________

2________________________________________________________

3________________________________________________________

4________________________________________________________

“Olympic Trial” (see description on page 7) o Sun., April 7, 4 – 6pm Event(s) I’m interested in:

1____________________________ 2___________________________

3____________________________ 4___________________________

Soccer o Soccer Kick, Accuracy – (Mon., 1:30 – 3pm)

o Soccer Kick, Distance – (Sat., 1 – 3pm)

Softball Homerun Derby o Softball Homerun Derby – (Mon., 1 – 3pm) Softball Throws o Softball Throw, Accuracy – (Mon., 11am – 1pm)

o Softball Throw, Distance – (Mon., 11am – 1pm)

Tap Dance (Tap dancers who participate in ONLY the Exhibition and Masters Class may register for $28. See Page 6.) o Master’s Class – (Thursday, April 25, 9am) Select : o Beginner o Intermediate o Advanced o Tap Dance Exhibition in memory of LaVerne Strotheide – (Thursday, May 23, 1:30pm) Select: o Solo o Group Name:_______________________ Weightlifting o Weigh In – (Sun., 10am - 2pm) o Arm Curls – (Mon.) (Men 50-59: 8:30am) (Women: 10:30am) (Men 70+: 10:30am) (Men 60-69: 12:30pm) o Bench Press – (Mon.) (Men 60-69: 8:30am) (Men 50-59: 10:30am) (Women: 12:30pm) (Men 70+: 12:30pm) o Leg Press – (Mon.) (Women: 8:30am) (Men 70+: 8:30am) (Men 60-69: 10:30am) (Men 50-59: 12:30pm) Swimming — Jewish Community Center in Chesterfield o 200 yd. Freestyle – Sat., 2pm o 50 yd. Backstroke – Sun., 2:45pm o 100 yd. Breaststroke – Sat., 2:45pm o 200 yd. Individual Medley – Sun., 3:30pm o 50 yd. Butterfly – Sat., 3:30pm o 50 yd. Freestyle – Sun., 4:15pm o 100 yd. Backstroke – Sat., 4:15pm o 200 yd. Breaststroke – Sun., 5pm o 100 yd. Freestyle – Sun., 2pm o 200 yd. Backstroke – Mon., 2pm Track & Field — Gay Field (See Page 19-20 for age/gender event time breakdown.) o Javelin – Sun., 8am o Pole Vault – Sun., 9am o Standing Long Jump – Mon., 8am o Running Long Jump – Sun., 8am o 1,500 Meter Race Walk – Sun., 8am o 50 Meter Dash – Mon., 9:55am o 200 Meter Dash – Sun., 9:05am o 400 Meter Run – Mon., 11am o 1,500 Meter Power Walk – Sun., 9:45am o High Jump – Mon., 8am o Discus – Sun., 9am o Shot Put – Mon., 8am

o 50 yd. Breaststroke – Mon., 2:45pm o 100 yd. Butterfly – Mon., 3:30pm o 100 yd. Individual Medley – Mon., 4:15pm o 500 yd. Freestyle – Mon., 5pm

o 1500 Meter Run – Mon., 8am o 100 Meter Dash – Mon., 8:50am o Triple Jump – Mon., 9am o 800 Meter Run – Sun., 11:05am o 5,000 Meter Run – Labor Day, Sept. 2 o 10,000 Meter Run – Labor Day, Sept. 2

2013 Entry Form 15

Official Entry Form

Waiver

Waiver THE ST. LOUIS SENIOR OLYMPICS AND ITS SPONSORS STRONGLY RECOMMEND THAT EACH PARTICIPANT CONSULT HIS/HER DOCTOR IN REGARD TO PRACTICE, PREPARATION AND COMPETITION IN THIS PROGRAM.

STATEMENT OF PHYSICAL CAPABILITY

I warrant and represent to the sponsors that: I have prepared for the event which I have entered by practicing the same prior to my participation in the St. Louis Senior Olympics; I am in good physical health and condition and am physically able to compete in the events I have selected; I know of no physical restriction whatsoever which would prohibit my participation in the events that I have selected. I have been advised by the sponsors that it would be in my best interest to consult my physician prior to my preparation in regard to my participation in the St. Louis Senior Olympics; and I recognize and understand that the preparation and the competition may necessitate strenuous physical activity and could activate any unrecognized pre-existing cardiovascular disorder which I may have, thereby resulting in serious or life threatening physical harm to me.

PERSONAL INJURY RELEASE

As a condition of being permitted to participate in the St. Louis Senior Olympics, I, the undersigned participant, agree that: I recognize that participation in the St. Louis Senior Olympics necessarily involves risks of injuries and damages including but not limited to injuries, damages or losses relating to or resulting from slips, falls, collision, car accidents, drowning, trauma, health failure, and /or other mishaps. Possible injuries to me can include death, personal injury, property damage, loss of service and other injuries and damages. I assume full responsibility for any injuries, damages or losses which may occur to me and agree that the JCC of St. Louis and its sponsors, its agents, employees, representatives, volunteers, and assigns, and all other persons, firms, and other entities participating or providing services or facilities to or for the benefit of Senior Olympics and/or its participants, hereinafter collectively referred to as the (“JCC”) shall not be individually or severally liable for any damages arising from any personal injuries that I may sustain in connection with my preparation for and/or participation in the St. Louis Senior Olympics whether or not the injuries, damages or losses occur on /or about the premises of the JCC of St. Louis, owned or not owned, in the conduct of the Senior Olympics. I hereby fully and forever release and discharge and hereby agree to indemnify and hold harmless the JCC from any and all present and future claims, demands, damages, rights of action, or causes of action including, but not limited to, reasonable attorney’s fees and costs collectively (“Claims”) arising out of, resulting from, or connected in any way with my preparation for and/or participation in the St. Louis Senior Olympics, whether known or unknown, anticipated or unanticipated, and specifically including, but not limited to, any claims arising out of or resulting from the negligence or fault of the JCC. Notwithstanding any language herein to the contrary, this release and discharge shall in no way affect any claims which I cannot legally waive, such as grossly negligent acts, intentional acts occurring in the future, and acts done with malfeasance. I understand that I am releasing the JCC from liability to the full extent that the law allows not only from any risk inherently associated with participation in an athletic activity, but also any enhanced exposure to injury occasioned by any carelessness, negligence or fault of the JCC or anyone acting on the JCC’s behalf, including any and all liability for damage and injury or death to myself or to any person or property to the full extent that the law allows. I understand that THIS RELEASE OF LIABILITY IS INTENDED TO BE AS BROAD AS LEGALLY POSSIBLE, and I accept the terms as a condition of being permitted to participate in the St. Louis Senior Olympics. RELEASE FOR PERSONAL PROPERTY I acknowledge and agree that the JCC shall not be liable for any loss or theft of personal property and I release the JCC for any liability for loss or theft of any personal property in connection with the St. Louis Senior Olympics. CONSENT TO MEDICAL TREATMENT The JCC of St. Louis has my permission to have a physician treat me if needed during my participation in the St. Louis Senior Olympics. I hereby consent to any first aid, medication, medical treatment or surgery deemed necessary. I release all claims for injuries or damages incurred by me in the connection with the delivery of such care in good faith. This release is also a condition of participation if the St. Louis Senior Olympics. PUBLICITY CONSENT I authorize the St. Louis Senior Olympics and the JCC of St. Louis to use or publish my likeness in any form. I waive any right to inspection or for any compensation. OTHER RELEASES This release is intended to supplement any other releases that I have previously signed with the JCC and is not intended to amend, modify or revoke any other release now existing between the JCC and me. THIS WAIVER AND RELEASE AFFECTS MY LEGAL RIGHTS AND INCLUDES RELEASES OF LIABILITY WHICH ARE INTENDED TO BE AS BROAD AS LEGALLY POSSIBLE. I HAVE READ THIS WAIVER AND I UNDERSTAND WHAT I AM SIGNING.

Name____________________________________________________________________________________________________________Date___________________ Signature_______________________________________________________________________________________________________________________________

16 Senior Olympics

2013 St. Louis Senior Olympics

Volunteer Sign-Up All Volunteer Opportunities are listed on page 18. Please return this form by MAY 13 to: JCC, ATTN: St. Louis Senior Olympics, 2 Millstone Campus Drive, St. Louis, MO 63146 Upon placement into a volunteer position, you will be sent a confirmation letter along with all necessary information. Please contact the St. Louis Senior Olympics office at (314) 442-3279 if you have any questions.

Volunteer Information Last Name______________________________________________ First Name______________________________________ MI_________ Mailing Address___________________________________________________________________________________________________ Address

Phone # (

City

)________________________________________ Alt. Phone # (

State

Zip

)_________________________________________

Gender o Male o Female Birthdate________________________________________________________ Age______________________ E-mail Address_ __________________________________________________________________________________________________ (Optional) At the request of our funders please check one of the descriptions below corresponding to the ethnic group with which you identify. o African American o Asian o Bi/Multiracial o Caucasian o Hispanic/Latino o Native American/Alaskan Native o Other

Volunteer Specifics I volunteered for the 2012 St. Louis Games

o Yes

o No

I am a new volunteer:

o Yes

o No

I am also competing in this year’s Games

o Yes

o No

T-Shirt Size:

o Small

If yes, how did you hear about the Games? _____________________________

o Medium

o Large

o X-Large

o XX- Large

o XXX- Large

Venue Information (see Venue Map on page 22) MAIN VENUE - Jewish Community Center (Creve Coeur) COMMUNITY VENUES Packet Pick Up Accuracy Plug Casting Art Competition Badminton Basketball Throws Bocce BulletBall Football Kicks Football Throws Frisbee Toss Handball Homerun Derbies Horseshoes Racquetball Shuffleboard Soccer Kicks Softball Throws Squash Table Tennis Tap Dance Volleyball Washer Toss Weightlifting

3 on 3 Basketball – Jewish Community Center in Chesterfield Billiards – Teacher’s Billiards & Sports Café Bowling – Olivette Lanes Cycling– Columbia Bottom Conservation Area Darts – Blueberry Hill Golf—9 Hole – Creve Coeur Golf Course Golf—18-Hole – Norman K. Probstein Gold Course in Forest Park 7 v 7 Soccer Tournament – Tony Glavin Soccer Complex Swimming – Jewish Community Center in Chesterfield Tennis – Creve Coeur Racquet Club Track & Field – Gay Field Water Volleyball – Lutheran Senior Services at Laclede Groves

2013 Entry Form 17

Volunteer Opportunities Pre Games, Thursday, May 23 & Friday, May 24

Saturday, May 25

Event Prep Friday, May 3 o 10am-12pm

Administrative Volunteers Information Desk, Packet Pick-Up, Medal Distribution o 7-10am o 10am-1pm o 1-4pm

Event Prep Friday, May 10 o 10am-12pm Event Prep Friday, May 17 o 10am-12pm

Water Volleyball o 8:30am-12:30pm o 12:30-4:30pm Administrative Volunteers Friday, May 24 Information Desk & Packet Pick-Up o 7-10am o 10am-1pm o 1-4pm

Event Prep Thursday, May 23 o 10am-12pm

JCC Event Volunteers – Outdoors o 8:30-11am o 10:30am-1pm o 12:30-3pm o 2:30-5pm Swimming o 1:30-4:30pm

Tap Exhibition and Packet Pick-up Thursday, May 23 o 1-4:30pm

Sunday, May 26

Monday, May 27

Administrative Volunteers Information Desk, Packet Pick-Up, Medal Distribution o 7-10am o 10am-1pm o 1-4pm

JCC Event Volunteers – Indoors o 8-11am

JCC Event Volunteers – Outdoors o 8:30-11am o 10:30am-1:30pm o 12:30-3:30pm

JCC Event Volunteers – Outdoors o 8:30-10:30am o 10:30am-12:30pm o 12:30-3:30pm Swimming o 1:30-6pm Track & Field o 7:15am-1pm

18 Senior Olympics

Swimming o 1:30-6pm Track & Field o 7:15am-1pm

2013 St. Louis Senior Olympics

Track & Field Detailed Schedule These are approximate starting times. Please arrive 10-15 minutes prior to the start of your event. Field event results will be tabulated at the end of the day. Results will be posted at the JCC in the afternoon.

Track Schedule

Sunday, May 26

Date

Field Schedule

Track (Sun., 8-11:25am)

Field

Time

Event/ (Gender & Age Group)

Time

Event/ (Gender & Age Group)