7/29/2019 2013 Entry Form

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2013 Torrance County 50+ Games

ENTRY FORM (complete BOTH sides)

Name Phone

Mailing Address

Email Age as of 12/31/13

Date of Birth First Year in Sr. Olympics? YES NO

Entry Fee check one: 1 sport $5 ___ 2 sports $8___ 3 or more sports $10____Entry Fee - Cash ___Check ___ (payable to Torrance County Senior Olympics)

Spouse name (or emergency contact)

Phone number(s) of emergency contact

All persons age 50 or older by 12/31/2013, are encouraged to participate in the Senior Olympicprogram. You must qualify by participating in the Local Games to be eligible to compete in the NM

State Senior Olympics in Roswell June 12 16.YOUR REGISTRATION FEE AND COMPLETEDREGISTRATION FORM MUST BE SUBMITTED TO JERRY MELARAGNO,P.O.BOX 496,MOUNTAINAIR,

NM87036 BY MARCH 8,2013 TO BE ELIGIBLE TO COMPETE IN THESE GAMES. On-site (walk-in)registrations will be accepted at a cost of $5 for each sport.

Liability Waiver

In consideration of being accepted in this event, I, the undersigned, intending to be legally bound, do hereby,for myself, my heirs, my personal representatives and assigns, waive, release, and forever discharge any and allrights and claims for damages which I may have or may hereafter occur to me against PMS, Torrance County,any facilities holding competition, NM Senior Olympics, Inc., or any other NM Senior Olympic Sponsor, or theirofficers, agents, representatives, successors, assigns or any other corporations or individuals associated withthe NM Senior Olympics from any and all damages, claims, injuries or actions sustained or suffered inconnection with my association or entry in or arising out of my participation in said event. If in doubt as to myphysical condition to engage in the event, I have been advised to seek the advice of a competent physician, and

to abide by his/her advice. I attest and verify that I have full knowledge of the risks involved in this event andthat I am physically fit and sufficiently trained to participate in this event. Further, I grant full permission toany and all the foregoing to use my likeness participating in this event without obligation or liability to me.

Further, I agree to abide by all rules and regulations of the NM Senior Olympics Games, Inc., to observe all

rules of play, to exercise good sportsmanship and follow all written and oral instructions given by authorizedpersonnel of the Games. I agree that failure to so act may result in my disqualification or suspension from theGames.

Signature Date