INFORMATION IMPORTANT INFORMATION. DON T FORGET: YOU CAN NOW REGISTER ONLINE

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2 INFORMATION IMPORTANT INFORMATION 1. REGISTRATION: Online (at or complete the enclosed Registration Form, and return it, along with your check or money order and a copy of your driver s license (1st time participants) as proof of age to: Greater Baton Rouge Senior Olympics/District Games ATTN: Corey Willimas EBRCOA 5790 Florida Blvd 2. ENTRY FEE: All participants must pay a $20 Basic Entry Fee for up to 3 sports, if you participate in more than three sports there is an additional fee of $5.00 for each sport above three (there are a total 0f 20 events, including Track & Field). Some sports have additional fees: Bowling $8 each event; Golf $55 for green fee, cart and lunch; Skeet and Trap Shooting $15 for each event/gauge; Tennis $15 court fee and Volleyball $8.00/player. 3. WEATHER POLICY: Game Officials reserve the right to cancel or postpone events due to inclement weather or unusual and/or extenuating circumstances. There is NO REFUND due to weather, although cancelled games will be rescheduled. 4. AGE GROUPS: Age group is determined by age as of 12/31/15. Age group for doubles & mixed doubles is determined by age of youngest partner (also known as playing down ). 5. TEAM SPORTS: Team Captains must call the GBRSOG Office at ext.208 to request a team registration form. Each team member must still complete an individual entry form and pay entry fees. Age group will be determined by the age of youngest member as of 12/31/ EQUIPMENT: Equipment will be provided for each event with the exception of: Golf, Table Tennis, Tennis, Pickleball & Pole Vault. Athletes may elect to use their own bowling ball & shoes as well as Discus, Javelin, & Shotput. Personal field implements are to be certified by a track & field official prior to start of competition. 7. QUALIFYING for STATE GAMES: There are 28 sports and 78 events offered at the Annual State Games. Ten (10) of these events require that an athlete qualify at a sanctioned district game. GBRSOG offer all ten sanctioned qualifying events. To compete in the ten (10) qualifying events at the State Games, participants must place 1st, 2nd or 3rd or have a minimum qualifying score. Qualifying events are Bowling Singles, Dance, Golf, Discus, Javelin, Shot Put, Horseshoes Advanced, Shuffleboard Advanced & Doubles, and Table Tennis. 9. CONFIRMATIONS/CHANGE OF TIME: in the event of a date or time change, participants will be notified by contact information provided on respective registration form. Contact Corey Williams or Trudy Bihm regarding any questions you may have: Phone: , ext cwilliams@ebrcoa.org or tbihm@ebrcoa.org DON T FORGET: YOU CAN NOW REGISTER ONLINE

3 RETURN THIS FORM ALONG WITH: 1) waiver; 2) entry fees; and 3) birth date verification to: greater baton rouge SENIOR OLYMPICS/DISTRICT games = 5790 florida blvd. = baton rouge, la (please print) Last Name: First Name: Sex: Date of Birth: Last 4 Digits of SS# Address: City: State: Zip: Parish: Home Phone: ( ) Work Phone: ( ) Cell: ( ) Signature for Waiver (see following page): CHECK EACH SPORT AND EVENT IN WHICH YOU WISH TO PARTICIPATE IN (*) 2015 qualifying SPORTS SWIMMING: ARCHERY: Backstroke: Breaststroke: Compound Release Compound Finger 50m 100m 50m 100m Recurve Bare Bow 200m 200m Butterfly: Freestyle: BILLIARDS 50m 100m 50m 100m BOWLING: 200m 200m 500m Singles* Individual Medley: Doubles Partner: 100m Mixed Doubles 200m Partner: TABLE TENNIS: GOLF* Singles* HORSESHOES: Doubles Partner: Advanced* Mixed Doubles Partner: PICKLEBALL TENNIS: (choose two) Doubles Partner: Singles Doubles Partner: Mixed Doubles Partner: Mixed Doubles Partner: POWERLIFTING Benchpress Deadlift Squat SHUFFLEBOARD: Advanced Singles* Doubles* Partner: SKEET SHOOTING: (please indicate 12 or 20 gauge) 12 gauge 20 gauge FUN EVENTS ($10.00 Basic Entry Fee) XBOX Bowling Tournament Party Bridge Spades Tournament ENTRY FEES (Checks made payable to Greater Baton Rouge District Games) Entry Fee for 3 competitive events... $20.00 Entry Fee for 3 fun events (Wii Bowling, Bridge)... $ Additional Fee(s) Spades Tournament $5 each sport OVER 3... x $5 = Bowling ($8.00 singles; $8.00 doubles; $8.00 mixed)... = Golf ($55.00) (open to ages 40+)... = *Skeet/Trap Shooting ($15.00/event; 3 events)... = Tennis ($15.00)... = Volleyball ($8.00/person)... = Contribution (tax deductible) $1.00 (or more) = Circle T-Shirt Size: S M L XL XXL (additional $1) XXXL (additional $2) = (*one shirt per participant) TOTAL ENCLOSED $ *Price does NOT include shells; if participants require shells, there will be an additional charge of $10.00 for EACH box of shells. TRACK & FIELD: 50m 1500m Race-Walk Long Jump 100m Discus* High Jump 200m Shot Javelin* Put* Triple Jump 400m 800m 1500m Run Javelin* Pole Vault TRAP SHOOTING (please indicate 12 or 20 gauge) 12 gauge 20 gauge VOLLEYBALL Team Name: WEIGHTLIFTING: Clean and Jerk Snatch Deadline to register is March 20, 2015: Mail all entries to: Greater Baton Rouge District Games ~ East Baton Rouge Council on Aging 5790 Florida Blvd. OR call for more information You may also register online at: We need your support! DONATE TODAY! HELP US CONTINUE SENIOR OLYMPICS. ALL DONATIONS ARE TAX-DEDUCTIBLE. $1.00 (or more). You may donate online: Please type Senior Olympics in the text field labled purpose.

4 required documentation WAIVER 2. Participant Waiver & Model Release (Sign Below) In consideration of being allowed to participate in any way in the Louisiana Senior Olympic Games program, related events and activities, the undersigned acknowledges, appreciates, and agrees that: 1. The risk of injury from the activities involved in these programs is significant, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury to me does exist; and, 2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and, 3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in my readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official immediately; and, 4. I, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE the East Baton Rouge Council on Aging, its officers, officials, agents and/or employees, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct the event ( Releasees ), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property incident to my involvement or participation in these programs, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law. 5. I, and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I, the undersigned participant, grant to the East Baton Rouge Council on Aging, the right to use any pictures taken of me during the Greater Baton Rouge Senior Olympic Games without my remuneration and in any medium the photographer/staff sees fit for art, advertisement, exhibition, editorial, or any purpose whatsoever. I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT. SIGNATURE: PRINT: DATE: Emergency Contact: Phone:( )

5 % EVENT SCHEDULE % EVENT CHECK IN START TIME LOCATION April 8, 2015: Party Bridge 8:00am 9:00am St. James Place (225) Lee Drive Baton Rouge, LA April 11, 2015: Volleyball 8:30am 9:30am April 16, 2015: Xbox Bowling 9:00am 9:30am Coquille Parks & Recreation Highway 1085 Covington, LA EBRCOA (225) Florida Blvd. April 18, 2015: Track and Field Track Events 10:00 a.m Race/Walk 11:00 a.m Meters 11:30 a.m Meters 12:00 p.m Meters 12:30 p.m Meters 1:00 p.m Meters *Check-IN will start at 7:30am for Field Events Field Events 8:00 a.m. - Discus Throw 9:00 a.m. - Long Jump 10:00 a.m. - Pole Vault 10:30 a.m. - Shot Put 12:00 p.m. - High Jump 12:30 p.m. - Triple Jump 12:45 p.m. Javelin *Times listed are an approximation. 9:00am 1st 10:00AM; rolling start time for subsequent races REMINDER! * Please make sure that you are properly hydrated before participating in all 2015 Senior Olympic Events. In the event you have any physical complications, please locate a Volunteer or the nearest EBRCOA Staff Member. Southern University 801 Harding Blvd, Baton Rouge, LA April 19, 2015: Skeet & Trap Shooting 8:00am 8:30am April 21, 2015: Swimming 7:30am 8:00am April 24, 2015: Bowling 8:30am 9:00am April 26, 2015: Golf 8:00am 9:00am Hunter s Run (225) N. West Drive Port Allen, LA Crawfish Aquatics (225) Bluebonnet Blvd. Baton Rouge, LA All Star Lanes (225) Airline Hwy. Baton Rouge,LA Copper Mill Golf Course (225) Copper Mill Dr. Zachary, LA 70791

6 % EVENT SCHEDULE % EVENT CHECK IN START TIME LOCATION April 29, 2015: Shuffleboard 8:00am 8:30am St. James Place (225) Lee Drive Baton Rouge, LA May 1, 2015: Billards 11:00am 11:30am May 2, 2015: Pickleball 7:30am 8:00am May 7, 2015: Spade Tournament 12:00pm 12:30pm May 8, 2015 : Horseshoes/ 7:30am 8:00am Table Tennis May 16, 2015: Archery 8:00am 9:00am May 17, 2015: Power/Weightlifting 9:30am 10:00am May 21-22, 2015: Tennis Singles, Doubles, Mixed Doubles 65-69; 70-74; 75-79;80-84; 85-89;90+ WILL CALL WILL CALL Singles, Doubles, Mixed Doubles 50-54; 55-59;60-64 WILL CALL WILL CALL Clicks Billiards (225) Corporate Blvd. Pete Maravich Assembly Center (225) N. Stadium Rd, Baton Rouge, LA EBRCOA (225) Florida Blvd. BREC Independence Park (225) Independence Blvd. Waddill Wildlife Refuge (225) N. Flannery Road Baton Rouge, LA Spectrum Fitness Club (225) ; (225) Monterrey Dr., Baton Rouge BREC Forest Community Park (225) South Harrell s Ferry Road Baton Rouge, LA Contact Corey Williams or Trudy Bihm regarding any questions you may have: Phone: , ext cwilliams@ebrcoa.org or tbihm@ebrcoa.org DON T FORGET: YOU CAN NOW REGISTER ONLINE

7 Welcome to the 2015 Greater Baton Rouge Senior Olympics/District Games. By registering for this year s competition, you are taking the first step to qualify for the 2015 Louisiana Senior Olympic Games (LSOG) held in the fall right here in Baton Rouge. Each year, thousands of athletes come from all over the state of Louisiana (as well as surrounding states) and arrive in Baton Rouge to test their physical grit amongst other 50+ athletes. In addition to annually hosting the Greater Baton Rouge Senior Olympics/District Games and the Louisiana Senior Olympic Games, Baton Rouge continues to be an avid supporter of the National Senior Games. Each year, Baton Rouge hosts the Greater Baton Rouge District Games that serve as a stepping-stone to the state games (held annually in the fall) as well as the national competition (held every odd year). Both the Louisiana Senior Olympic Games and the National Senior Games Association s corporate headquarters are based in Baton Rouge, with both of these organizations helping to shine a national spotlight on our continuing efforts to emerge as America s next great city. Both not-forprofit organizations, the Louisiana Senior Olympic Games and the National Senior Games Association are dedicated to motivating active seniors to lead a healthy lifestyle through sports, training and competition. All three of these programs complement Baton Rouge s own Healthy Cities Initiative, an effort to promote healthy eating and active living across our city. The U.S. Conference of Mayors launched The Mayors Healthy Cities Initiative in response to America s growing obesity problem and its relationship to chronic diseases which may be prevented or lessened through regular exercise and healthy eating. I was eager for Baton Rouge to participate in this effort by promoting both the benefits of a healthy lifestyle and the helpful resources available in our community. Through our Healthy Cities Initiative, we have made major strides in making Baton Rouge a bike-friendly community, becoming the first Louisiana city ever to be recognized by the League of American Bicyclists. Again, thanks for your interest in the Greater Baton Rouge Senior Olympics District Games and best of luck in your upcoming competition. Mayor-President Melvin Kip Holden Do you have both Medicare and Medicaid? Make sure you re getting the extra benefits you deserve and learn more about the advantages of a Medicare Advantage plan from Peoples Health. If you have both Medicare and Medicaid (or other state assistance) call Peoples Health today for free information about benefits that go beyond Original Medicare. Call toll-free, (TTY:711) 8 a.m. to 8 p.m., Monday through Friday. Call For a FREE Information Kit with no obligation Walter S., Peoples Health plan member Peoples Health is a Medicare Advantage organization with a Medicare contract to offer HMO plans. Enrollment depends on annual Medicare contract renewal. H1961_DualSO Accepted

8 NONPROFIT STD US POSTAGE PAID Baton Rouge, LA PERMIT NO Florida Blvd. CRAWFISH Aquatics