Mesquite Senior Games Athlete Registration Form 2008

Last Name_______________________________First Name ______________________________ Mailing Address__________________________________________________________________ City_____________________________________________________State________Zip_____________ Country_____________________________________Phone____________________________________

Shirt Size (m/f) S / M / L / XL / XXL / XXXL Date of Birth _________(Day/Month/Year) Gender M/F

Standard Registration Fee $20.  Please make checks payable to Mesquite Senior Games and mail to P.O. Box 2079, Mesquite, NV 89024.  Please note that you must be the age of the category you are entering this year.  For more information, call 703/346-0244.  Deadlines for guaranteed entry depends on the individual event.

 Total dollars for all events you are entering _____  Donation (Thank you) _____ .Grand Total _____

Note: Softball does not require individual registration or fee.

Summary of Individual Fees

Select Games you wish to enter:

  1. Archery Longbow $5___ Recurve $5___ Compound Fingers $5___ Compound Release $5___

  2. Basketball Skills $5___ (includes free-throw, hotshot & 3-point).

  3. Basketball 3 on 3 teams $5 per player___ Team Name___________________________ Each  player must fill out separate registration form.

  4. Bowling Scratch $8___ Handicap $8___ (Your Average__) Doubles $8 per bowler___ Partner____________________(must fill out separate registration form). (Alley fees included.)  I need a partner___

  5. Golf 18 Holes $40___ 9 Holes $30___ (green fees included).

  6. 6. Swimming (Maximum entry fees $15) Freestyle: 25 yards $5___ 50 yards $5___ 100 yards $5___ 500 yards $5___ Backstroke: 25 yards $5___ 50 yards $5___ 100 yards $5___ Breaststroke 50 yards $5___ 100 yards $5___

  7. Team Softball (call Frank Pati at 702/346-7211).

  8. Track & Field 5k run $5___ 400 meter run $5___ 1500 meter run $5___ 50 meter sprint $5___ 100 meter sprint $5___ 200 meter sprint $5___ 1500 race-walk $5___ Standing Long Jump $5___ running long jump $5 ___ Shot Put $5___ Javelin throw $5___ Discus $5___

  9. Sporting Clays 50 Target 5-Stand $16 ___

  10. Tennis singles $5 ___ doubles $5 ___ mixed doubles $5 ___

  11. Softball Throw $5 ___.

Amateur Athletic Waiver and Release of Liability

For being allowed to participate in the Mesquite Senior Games program, the undersigned participant agrees to all of the following: To inspect facilities and equipment in use, and if unsafe, to notify the MSG supervisor and refuse to participate. He/she acknowledges that each participant will engage in activities that involves risks and accepts personal responsibility for all possible consequences including injury or death; agrees not to sue Mesquite Senior Games, its officials, representatives, sponsors and participants for death, injury or damage to property caused, or allegedly caused, in whole or in part by negligence of the release. He/she warrants that he/she is in good health and condition and has contacted their physician to learn this fact. MSG officials or their designated medical professionals have permission to provide emergency medical treatment if needed. He/she grants the MSG and its sponsors the right to use their names and pictures and video or audio taken during the 2005 Mesquite Senior Games.

Signature __________________________________________________________ Date __________