2017 INFORMATION & REGISTRATION GUIDE · PDF fileto participate is to win! information & registration guide proudly sponsored by 2017 mdseniorolympics.org

TO PARTICIPATE IS TO WIN!

INFORMATION & REGISTRATION GUIDE

PROUDLY SPONSORED BY

2017 mdSeniorolympiCS.org

CONGRATULATIONS AND BEST OF LUCK TO ALL OF OUR MARYLAND ATHLETES COMPETING AT THE NATIONAL SENIOR GAMES IN BIRMINGHAM, ALABAMA!Yvonne AasenWahidah AbdullahLynn AdamsDavid AlexanderDievah AllenRalph AllenRex AllenLynne AndrewsBetty ArmacostEmery AtkinsonZonnie AytonAlethea BageantWilliam BaityRaymond BakerDaniel BankusSally BarcusCarolyn BarkerThomas BarnaDonna BarrettSandra BarrettDena BauerGary BauerCherie BeallDiane BenedettaMargaret BennettNancy BergerBarbara BitgoodMartine BohnDeborah BordaPhilip BowersMichael BoyleMarsha BradleyHedy BrandtBarbara BriggsMary BrochBurt BronkFay BrooksEllis BrownJames BrownRaymond BrownGeorgia BurressErnest BylesMary ByrnesCarmen CampbellJoann CarnathanJennifer CarrGail ChambersBruce ChandlerBen ChangPeter ChenSi CheongJill ChildersRonney ChoongPravit ChoonitLily ChuaColin ChurchJerry ClarkMichael ClarkeEmilie ClassRon ClontzSandy ClontzBerdetta ColbertJohn CollingsMary ConlonLynn ConnellyCharles CooperJerome Cooper

David CromerBeverly CroninCarl CuneoCarol Ann CuneoSharon CuneoHenry DahlenBarry DancisElaine DancisGail DapolitoWally DashiellDarryl DavisJudith DavisNancy DavisJoan DelpiDarrell DempsterBrian DetweilerValarie DouglasSharman DysonClaire EdwardsAlane EmersonRobert EneyLaura FeinauerCindy FeldSteve FeldNorma FerrickRussell FinkPat FisherKathleen FiskenFrances FlatauOrvis FlygarCarolynn FoleyJuanita ForemanLisa FoucheRon FowlerVeryl FrahmDoug FraileyAlex FraschettiLinda FrazierWilliam GaineyBarbara GarnerThomas GartonF. Stacy GawronskiBeverly GehringShirley GeisbertTracey GershNeal GillenJennifer GillinsJoy GoldbergKaren GomezTami GrafAdrianne GrafmanCathy GrahamTerry GravesLinda GreenbergRobin GreenfieldPamela GroszSusan HabigJeanne HallCheryl HammondKathleen HansonWilliam HarbackJames HarbaughLaverne HarrisLisa HarveyJoseph HawkinsTerrance HawkinsKathy Hennes

Thomas HenryKathy HerringKen HickeyDaryl HillSteve HochmanShelagh HodsonGil HoffmanKathy HollandCharles HollisAngela HollowaySharon HolzmanGloria HongDeborah HoppeElia HowserJin-Chung HsuWilliam HunsbergerSheila HutchisonGeorgia IrwinNichole IrwinGeorge IzumiWyatt JarvisElisabeth JerniganThomas JohnAmy JohnsonJulia JohnsonSonya JohnsonWendy JohnsonBarbara JonesBruce JonesSharon JonesSylvia JonesMichele JordanJane JumpMichael JumpJeff KaseDouglas KatzenbargerJohn KeenanJames KenneyVeronica KerrMelvin KetchelKathy KeysMichael KiddElizabeth KilgusVirginia KingVicki King-TaitanoKenneth KlebanowKenneth KleinhansBill KlemmKirk KleyLinda KosydarJoyce KraimerEd KrestFrancis KreysaElaine KujawaKaren KushnerRobert LangLinda LangePaul LargentMary LaufferSteve LawrenceSue LeachLarry LeeLiz LeeMesanie LeeYoungja LeeMonica LeidIvan Leshinsky

Carol LewisStanlee LipkinMei-Li LiuSu LiuJames LoganKim LongChester LordDavid LoudenRussell LoyChris LucasPhillip LucasPatty LycettePercy Mack Paula MackeyBill MadertMary MalinauskasMark MaloneShirley MarklandGillian MartinPatricia MartinKaren MaszkiewiczRay MayLloyd MayesTerry MayoLori McCrackenGwendolyn McFaddenJan McGarryDon McGeeMisty McgillGerard McIntyreGretchen McMullenLenny McNairSusan McPhersonNancy MenzClemuel MercerDavid MerkowitzClifford MeyersRobert MintzBill MitchellJanet MitchellMike MondYetlie Morales-MacedoCathie MorrisonJeffrey MorrisonGreg MortNadine MortChristine MoserMari Beth MoultonJames MurduckAlan MurrayMaureen MurrayTom MurtaughNorbert MyslinskiCharlene Neill-RoeSandra NewmanLaurie NickchenMax ObuszewskiMichael OkalaSylvia OkalaBob O’MalleyClaire O’NeillJohn OrdLinda OrffGrant OrrCarol OtisMary OwenSteve Owens

Barbara PadgettLoyce PailenSusan PappasBobby ParkerDiane PaterlineDan PawlakCharles PeddicordConstantine PergantisRonald PerryJoann PessagnoOscar PeytonAnnette PittmanMarie PohidaGeorge ProbeyahnGeorge PrudenClifford PurcellRichard PyesMark RadomCarl ReedPatricia RehertWayne ReisbergSteve RoatCynthia RobersonEva RodriguezJanet RogersDenise RohrDebbie RorabaughAllison RoweDeborah RowensHarold RowsonRenee RozichSue RubleHarold RussellTheodore RussellBeverly RyanVictoria SandersGwendolyn SanfordPhyllis SassoneSteven SchaefferBarbara ScheffterCarol SchulmanTerry ScottJoseph SeditaCandice SegalMyron SegalTammy SellersCharles ShafferKatrina ShafferReza ShafiiJim SharpsDavid SheriffBarbara ShipDavid SilbermanEdwin SimmonsClaudia SimpsonDave SimpsonMary SloanJeffrey SmartYvonne SmartAntoinette SoaresHoward SparkmanMary Helen SprecherLynn SpringerFaith StanleyShari SternbergDavid StinsonRonnie Stokes

Patti StouteRichard StrawderRobert Stroud JrTerri StuckCharlene SuggsJoe SullivanMarian SullivanBeverly SupanickThomas SwartzBradford TatumCharles Thomas IIIZac TolinJoseph TouzinStephen TreichelCarol TresslerLouis TriandafilouSandy TrioloPam TruxalJohn Urdahl, SrRosanne UrickThom UrickEllyn VailJohn VailRand VaillancourtMichael Richard VarleySharon WalkerDennis WallaceFrank WarnerLawrence WashingtonBernie WatkinsCatherine WatkinsRon WatsonDonna WayshnerDaniel WeaverLinda WebbRonald WestJames West, Jr.Patricia WestonDaniel WheatleyJoyce WheatleyBeth WheelerBrian White Meg WhitefordJamie WhitingGergory Williams Jesse WilliamsStacey WilliamsTom WinkertBrad WinnAngela WoodardGwendolyn WrightIda WrightJoy WyneJerry YetterBarbara YoungJohn ZarkowskyJianping Zhou

mdseniorolympics.org 3

welCome!

In its 37th year, the Maryland Senior Olympics has played a major role in helping promote physical fitness and well-ness for active adults aged 50 and above. MSO will host over one thousand athletes with events in Montgomery, Howard, Prince George’s, Baltimore, Anne Arundel and Frederick counties.

Our motto is, “To Participate Is to Win!” Join us for the friendly competition, camaraderie and to stay active.

This guide will help you understand the Maryland Senior Olympics and give you the necessary information to get registered. Individuals can register online or by mail-in forms. Teams are mail-in only. Questions? Visit our website at www.mdseniorolympics.org or call 240-777-4930.

PARTICIPATION!The Maryland Senior Olympics Commission requests that every participating athlete consult his or her physi-cian to evaluate their physical condition and determine your safe level of competition. Each event is rated as either high or medium risk. Participants may enter as many sports as their schedule will allow. Here’s what you need to know:

HIGH-RISK PARTICIPATIONThese events require an extensive level of physical fit-ness and training. Do not engage in these events unless:

1.) You are actively participating in an event of this nature on a regular basis (a minimum of three times a week for at least one year); 2.) Your doctor’s consent has been given if you have been diagnosed as having high blood pressure, heart disease, respiratory conditions or ortho-pedic disorders. You can participate in just two high-risk events per day, except in swimming and track and field.

MEDIUM-RISKThese events require less extensive physical condition-ing but have some risk due to their highly competitive nature. Do not engage in an event of this caliber unless: 1.) You have been actively involved in a similar event for the past six months; 2.) You have your doctor’s consent if

you have been diagnosed as having high blood pres-sure, heart disease, respiratory conditions, or orthopedic disorders.

AGE GROUPSGender and age group competitions will be conducted in men’s and women’s divisions in each of the following age groups: 50-54, 55- 59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94, 95-99 and 100-plus. If participant numbers are insufficient, age groups may be combined for competition purposes. However, medals will be awarded within each division and age category. For all competitions, your age group is determined by your age as of Dec. 31, 2017.

TEAM SPORTS COMPETITIONMaryland Senior Olympics offers three team sports: 3-on-3 half-court basketball, softball and volleyball in the following age groups: 50-54, 55-59, 60-64, 65-69, 70-74 and 75-plus. The youngest member of the team as of Dec. 31, 2017 will determine the age division. No roster substitutions will be permitted after the registration deadline. Register by mail-in form only.

REGISTRATION!Deadline to register is two weeks prior to the first event of each scheduled sport. There is a $10 processing fee for each mail-in registration and a $5 processing fee for each online registration. There is a $10 non-Maryland resident fee (not charged for $15 events). For mail-in reg-istration, fill out the forms in the back of this guide and mail them to us. For online registration, go to https://maryland.nsga.com/registration/538/. Payment is by credit card or PayPal account.

IN 2017, MSO FEATURES 23 SPORTS, INCLUDING AN EXPANDED PICKLEBALL SCHEDULE.

4 mdseniorolympics.org

Events!

IMPORTANT INFORMATIONWhen registering for partnered events have your part-ner’s full name and date of birth. Teams may register by mail-in forms only. Team Captains should obtain all necessary information for each athlete on the 2017 Team Roster Form. Please print clearly (or attach a typed list) and note that in addition to the team fee there is a $5 per player online administration fee.

GENERAL INFO!Things you need to know as a competitor and partici-pant in the Maryland Games.

CANCELLATION AND RAIN DATESMSO officials reserve the right to cancel any event due to insufficient registration and/or combine age groups if fewer than five people sign up in an age group. In the event of inclement weather or unusual and extenuating circumstances, MSO officials reserve the right to cancel or postpone events to a later time or date. Note: The $5 online and $10 mail-in processing fee is non-refundable.

REFUND POLICYHalf of the participation fee and all of the additional fees will be refunded if registration is withdrawn in writing at least two weeks prior to the participant’s first competi-tion date. No requests can be honored after that date.

RULES AND EQUIPMENTMSO follows NSGA rules, visit www.mdseniorolympics.org to view. Participants are required to provide their own equipment for the events entered except where specified in an event’s special instructions.

EVENT CHECK-INEvery athlete must check-in with the event coordinator 30 minutes prior to each sport at the event location. Any athlete not reporting to an event on time may be disqualified. There will be no switching of events on day of competition. Participating in an event that you are not pre-registered for will result in disqualification.

AWARDSGold, silver and bronze medals will be presented to the first-, second- and third-place Maryland finishers in each age group for each event. Out-of-state finishers that place in the top three also receive medals. Ribbons are given to fourth-, fifth- and sixth-place finishers. Awards will be presented at the event site or may be picked up by appointment at the Maryland Senior Olympics office. No awards will be mailed.

NSGA EVENTSMSO offers these National Senior Games Associa-tion-sanctioned events. The top three finishers in these events win gold, silver and bronze medals.

ARCHERYSEPT. 24, 9 AMMen, Women: Barebow Compound, Barebow Recurve, Compound Fingers, Compound Release, Recurve

$30 first event, $5 each additional

RISK: Medium

Genesee Valley Outdoor Learning Ctr 1717 Rayville Rd. Parkton, Md. 21120

BADMINTONSEPT. 9, 9 AM

Singles, Doubles, Mixed Doubles


RISK: Singles-High; Doubles-Medium

North Potomac Community Center 13850 Travilah Rd, Rockville, MD 20850


BASKETBALL (3 ON 3)SEPT. 16 (WOMEN); SEPT. 17 (MEN), 9:30 AM

$125 per team (+$5 per athlete administration fee)

RISK: High

White Oak Community Center 1700 April Lane Silver Spring, MD 20904

BASKETBALL SKILLSSEPT. 16 & 17, 10:00 AM – 1:00 PM

Floor, Foul and Free shot

$15 for all three

RISK: Medium

White Oak Community Center 1700 April Lane Silver Spring, MD 20904

BOWLINGAUG. 28 (SINGLES) & AUG. 29 (DOUBLES)

SINGLES: 50-69 9AM, 70+ 1PM

DOUBLES: MEN’S/WOMEN’S, 9AM; MIXED, 1PM

$30 first event, $5 each additional; $8 lane fee per event

RISK: Medium

Brunswick Normandy Lanes 8419 Baltimore National Pike Ellicott City, Md. 21043

CYCLING 5K AND 1OK TIME TRIALSAPRIL 5 (10K) & MAY 3 (5K), 6PM

$15

RISK: High

Davidsonville Elementary School 962 W. Central Ave. Davidsonville, Md. 21035

GOLFOCT. 2, 9AMMen, Women: Golf, Chipping, Putting

$30 first event + $50 golf fee (includes green fee, cart, lunch), $5 each additional

RISK: Medium

Laytonsville Golf Course 7130 Dorsey Rd. Gaithersburg, Md. 20882

HORSESHOESSEPT. 9, 9AM

Men, Women

$15

RISK: Medium

Maryvale Park, 506 W. Patrick St. Frederick, Md. 21702

PICKLEBALL AUG. 19 (SINGLES) & AUG. 25-27 (DOUBLES), 9AM


RISK: High (Singles), Medium (Doubles)

Singles Meadowbrook Athletic Complex 5001 Meadowbrook Ln Ellicott City, Md. 21043

Doubles City of Bowie Gymnasium 4100 Northview Dr. Bowie, Md. 20716

RACQUETBALLSEPT. 6 (SINGLES) & SEPT. 7 (DOUBLES), 9AM


RISK: High

Severna Park Racquetball and Fitness Center 8514 Veteran’s Hwy. Millersville, Md. 21108

RUNNING 5K RACESEPT. 2, KENTLANDS/ LAKELANDS 5K

RISK: High

Register at: kentlandsfoundation.org/annual-5K

267 Kentlands Blvd. Gaithersburg, Md. 20878

RUNNING 1OK RACE SEPT. 17, THE HERMAN & WALTER SAMUELSON CHILDREN’S HOSPITAL AT SINAI RACE FOR OUR KIDS

RISK: High

Register at www.raceforourkids.org

Pimlico Race Course 5201 Park Heights Ave. Baltimore, Md. 21215


SHUFFLEBOARDSEPT. 10, 9AM

Singles, Open Doubles


RISK: Medium

Leisure World 3701 Rossmoor Blvd. Silver Spring, Md. 20906

SOFTBALLSEPT. 7-8 (MEN’S) & SEPT. 9-10 (WOMEN’S)

$200 per team (+$5 per athlete administration fee)

RISK: High

Olney Manor Regional Park 16601 Georgia Ave. Olney, Md. 20832

SWIMMINGSEPT. 16, 8AM WARM-UPS, 9 AM START, 2 PM END

$30 first event, $5 each additional (6 max)

RISK: High

Germantown Indoor Swim Center 18000 Central Park Circle, Boyds, Md. 20841

Order of Events:

TABLE TENNISJULY 29, 9AM

Singles, Doubles, Mixed Doubles


RISK: Medium

Potomac Community Center 11315 Falls Rd. Potomac, Md. 20854

TENNISSEPT. 14-16, 8:30AM

Singles, Doubles, Mixed Doubles (2 max)


RISK: High

Olney Manor Regional Park 16601 Georgia Ave. Olney, Md. 20832

1. 400-Yard Individual Medley

2. 50-Yard Backstroke

3. 200-Yard Breaststroke

4. 100-Yard Freestyle

5. 200-Yard Butterfly













BILLIARDS (8-BALL)MAY 18 & 19, 9AM

Men, Women

$15

RISK: Medium

Margaret Schweinhaut Senior Ctr. 1000 Forest Glen Rd. Silver Spring, Md. 20901

BOCCESEPT. 29 & 30, 9AM

Singles, Doubles, Mixed Doubles $15

RISK: Medium

Margaret Schweinhaut Senior Ctr. 1000 Forest Glen Rd. Silver Spring, Md. 20901

CROQUETSEPT. 30 & OCT. 1

Register at www.westriverwickets.com or www.gingercove.com

Ginger Cove 4000 River Crescent Dr. Annapolis, Md. 21401

West River Wickets 120 Owensville Rd. West River, Md. 20778

DISC GOLFJUNE 17, DRUID HILL OPEN

RISK: Medium

Register at http://www.pdga.com/tour/event/31067

Druid Hill Park Greenspring Ave. Baltimore, Md. 21217

LAWN BOWLINGSEPT. 9, 9AM

Singles, Doubles, Triples


RISK: Medium

Leisure World 3701 Rossmoor Blvd. Silver Spring, Md. 20906

STATE EVENTSMSO offers these fun participatory events. They aren’t part of the NSGA but you can win MSO medals.

TRACK & FIELDAUG. 12-13, 9AMSee additional track and field event schedule


RISK: High (running events), Medium (field events, race walks)

Howard County Community College 10901 Little Patuxent Parkway Columbia, Md. 21044

VOLLEYBALLAUG. 26, 9AM$125 per team (+$5 per athlete administration fee)

RISK: High

Meadowbrook Athletic Complex 5001 Meadowbrook Ln. Ellicott City, Md. 21043


TRACK AND FIELD | SATURDAY, AUG. 12Schedule, event breakdown and health risks. Times are subject to change based on weather and participation. Check our website and at sign-in on the day of your event for potential time changes. Note: Athletes may enter only one of the 1-mile walk events.

TIME EVENT RISK

9 a.m. Hammer throw (men 70-79, followed by weight throw) Medium

9 a.m. Running long jump with standing long jump to follow (women, all ages) Medium

9:30 a.m. Javelin throw (men 80-plus) Medium

10 a.m. 1500-meter run (men) Medium

10:30 a.m. Javelin throw (men 70-79) Medium

10:30 a.m. 100-meter dash trials (if necessary) High

10:45 p.m. Running long jump (men 80-plus, followed by standing long jump) Medium

11:00 a.m. Hammer throw (men 50-59, followed by weight throw) Medium

11 a.m. 1500-meter run (women) Medium

12:30 p.m. 1500-meter race walk (men and women) Medium

12:30 p.m. Running long jump (men 70-79, followed by standing long jump) Medium

12:30 p.m. Javelin throw (men 50-59) Medium

1 p.m. Hammer throw (women, all ages, followed by weight throw for all ages) Medium

1:30 p.m. Javelin throw (men 60-64) Medium

1:30 p.m. 100-meter dash (men, oldest to youngest) High

2 p.m. Running long jump (men 60-69, followed by standing long jump) Medium

2 p.m. Javelin throw (men 65-69) Medium

2 p.m. 100-meter dash (women, oldest to youngest) High

2:45 p.m. Hammer throw (men 80-plus, followed by weight throw) Medium


2:45 p.m. 50-meter dash (women, oldest to youngest) High

3:30 p.m. Running long jump (men 50-59, followed by standing long jump) Medium

3:30 p.m. Javelin throw (women, all ages) Medium


3:45 p.m. 400-meter dash (women, oldest to youngest) High

4:30 p.m. Hammer throw (men 60-69, followed by weight throw) Medium


TRACK AND FIELD | SUNDAY, AUG. 13Schedule, event breakdown and health risks. Times are subject to change based on weather and participation. Check our website and at sign-in on the day of your event for potential time changes. Note: Athletes may enter only one of the 1-mile walk events.

TIME EVENT RISK

9 a.m. Triple jump (men 80-plus) Medium

9 a.m. Shot put (men 70-79) Medium

9 a.m. Discus throw (men 50-59) Medium

10 a.m.-2 p.m. Football, Frisbee and softball throws (men and women), open pit. Medium

10 a.m. 800-meter run (men) High

10:15 a.m. Shot put (men 50-59) Medium

10:30 a.m. High jump (men) Medium

10:30 a.m. Triple jump (men 70-79) Medium

10:30 a.m. Discus throw (men 60-69) Medium

10:45 a.m. 800-meter run (women) High

11:30 a.m. Shot put (men 60-69) Medium

11:30 a.m. 1-mile recreational walk (men and women) Medium

Noon High Jump (women) Medium

Noon Discus throw (men 70-79) Medium

12:30 p.m. Shot put (women 50-69) Medium


1 p.m. 200-meter dash (women, oldest to youngest) High

1 p.m. Triple jump (women, all ages) Medium

1 p.m. Pole vault (men and women) Medium

1:30 p.m. Shot put (women 70-plus) Medium

1:30 p.m. Discus throw (women 50-69) Medium

1:30 p.m. 1-mile precision walk (men and women) Medium

2 p.m. Triple jump (men 60-69) Medium

2:30 p.m. Shot put (men 80-plus) Medium

2:30 p.m. Discus throw (women 70-plus) Medium

3 p.m. Triple jump (men 50-59) Medium

3:30 p.m. Discus throw (men 80-plus) Medium

MARYLAND SENIOR OLYMPICS c/o Holiday Park Senior Center 3950 Ferrara Drive Wheaton, Md. 20906

www.mdseniorolympics.org

CONTACT USPhone: 240-777-4930 Email: [email protected]

DIRECTORYStacy Sigler, Montgomery County Recreation Liaison

SOCIAL MEDIAFacebook: www.facebook.com/mdseniorolympics

Twitter: www.twitter.com/mdsrolympics

YouTube: www.youtube.com/mdseniorolympics

Flickr: www.flickr.com/photos/66971082@N07

THANK YOU TO OUR HOSTS, PARTNERS AND SPONSORS!CAREFIRST, MONTGOMERY COUNTY RECREATION,

NATIONAL SENIOR GAMES ASSOCIATION, MONTGOM-

ERY PARKS (M-NCPPC), HOWARD COUNTY RECREATION

& PARKS, CITY OF BOWIE PARKS & RECREATION

Parvilla Cycle & Sport, Brunswick Zone Normandy Lanes,

Kentlands Community Foundation, Severna Park Racquet-

ball & Fitness Club, Frederick Horseshoes Pitcher Associ-

ation, Leisure World of Maryland, LifeBridge Health, MCG

Laytonsville Golf Course, Oriole Archers, Ginger Cove and

West River Wickets and Baltimore Disc Golf, Inc.

FULL NAME:

STREET ADDRESS:

CITY: COUNTY: STATE: ZIP:

BIRTH DATE (MO/DAY/YR): PHONE: E-MAIL:

EMERGENCY CONTACT: RELATIONSHIP: PHONE:

GENDER: MALE FEMALE STATUS: RETURNING ATHLETE NEW ATHLETE

Were you a professional or Olympic athlete? YES NO Sport/Events:

PLEASE VISIT THESE SITES TO REGISTER FOR. . .

PARTICIPANT DUES FEES NO. OF ITEMS AMT.

Participation in 1 Event (event with the highest fee) $15 | $30 | $35 one $

Each Additional Event $5 $

ADDITIONAL/OPTIONAL COSTS COMPLETE ALL THAT APPLY TO YOU FEES NO. OF ITEMS AMT.

Non-Maryland resident $10 one $

10-Pin Bowling for Each Event $8 $

Golf Fee (with cart) $50 one $

Your Tax-Deductible Additional Donation Is Greatly Appreciated! $

Mail-In Registration Fee (non-refundable) $10 $10

TOTAL $

FREE! YOUR MSO SOUVENIR T-SHIRT! CHOOSE YOUR SIZE: S M L XL 2XL 3XL

DID YOU. . . ?n Complete BOTH sides of the individual athlete registration form?n Check the “risk level” of each event (only TWO high-risk events per day, except swimming, and track and field)?n SIGN the liability waiver on the back of this form?n Include a copy of your driver’s license or MVA identification? (new athletes only)Enclose a check or money order payable to: MARYLAND SENIOR OLYMPICS (do not send cash)

FOR OFFICE USE ONLY

DATE RECEIVED: CHECK NO. CHECK AMOUNT: $ DATE REGISTERED

2017 INDIVIDUAL REGISTRATION FORMSNEW PARTICIPANTS MUST ENCLOSE A COPY OF A VALID DRIVER’S LICENSE OR MVA IDENTIFICATION.

PLEASE PRINT CLEARLY. FILL OUT AND SUBMIT BOTH SIDES.

REGISTRATION CLOSES TWO WEEKS PRIOR TO EACH EVENT.

n 5K RACE: www.kentlandsfoundation.org/annual-5k

n 10K RACE: www.raceforourkids.org

n CROQUET: www.westriverwickets.com or www.gingercove.com

[ ]


INDIVIDUAL ATHLETE REGISTRATION This form is for individual participants only. There is a separate form for team regis-trations. You must also fill out this form to list the individual events you wish to compete. Please complete each column of the form for each event you are entering, including your best time, score or distance for all swimming, golf, track and field events. On Risk Level, you can enter only two high-risk events per day—except for swimming, track and field.

MEDICAL INFORMATIONFor your safety, please list or attach a summary of all medical conditions, allergies, surgeries, medications, etc.

EVENT REGISTRATION AN “EVENT” IS DEFINED AS “ONE” ACTIVITY. FOR EXAMPLE, TENNIS SINGLES AND DOUBLES ARE TWO ACTIVITIES.

AGE GROUP RISK LEVEL EVENT DATE EVENT FULL NAME (E.G., 10-PIN BOWLING BEST TIME DOUBLES PARTNER’S NAME & DOB (NO DUPLICATES) SINGLES, ETC.

Each participant must present a valid driver’s license or MVA identification at check-in of events.

ENCLOSE CHECK OR MONEY ORDER AND MAIL TO: Maryland Senior Olympics c/o Holiday Park Senior Center | 3950 Ferrara Drive | Wheaton, Maryland 20906

LIABILITY WAIVERThe Maryland Senior Olympics Commission LTD strongly recommends that participants consult their physicians regarding practice, preparation, and competition in the Senior Olympics program. You must read and sign the following in order to participate in the Mary-land Senior Olympics:

I, the undersigned participant, shall and will save and keep harmless and indemnify the Maryland Senior Olympics Commission LTD, Montgomery County and all other sponsors, volunteers or any of their agents or employees from and against any and all liability and claims which I may have and/or persons through me may have, such as a spouse or children, for damages of any kind or nature, including but not limited to personal injuries or death caused in whole or in part by the negligent acts of omission or commission by said indemni-ties acting independently or jointly in the sponsorship, conduct or operation of the 2016 Maryland Senior Olympics.

I have prepared myself for the event(s) which I have entered by practicing prior to the Maryland Senior Olympics. To the best of my knowledge and belief, I have no physical restrictions which would prohibit my participation in the events that

I have selected. The Maryland Senior Olympics Commissions LTD has my permission to have a physician attend me if deemed necessary during my participation in the Maryland Senior Olympics.

I have read and understand all the information contained in the official form and the Risk Criteria as listed in the Mary- land Senior Olympics registration form, which must be met in order to compete in the 2016 Maryland Senior Olympics. Fraudulent statements on this application will result in disqualification.

The Maryland Senior Olympics Commission LTD reserves the right to photograph participants for publicity purposes.

SIGNATURE OF PARTICIPANT: DATE:

2017 INDIVIDUAL REGISTRATION CONTINUED...


This form is for teams wishing to participate in basketball, softball and volleyball competitions. There is a separate form for individual sports registrations. Even though many athletes participate in individual sports for the Maryland Senior Olympics and National Senior Games, the team sports differ widely.

First, each team captain must apprise his players of the risk levels for basketball (medium to high), softball (medium) and volleyball (high). Secondly, athletes must carefully address any medical conditions or medications against the higher-paced team sports compared to some of the individual sports.

HERE ARE OTHER THINGS YOU SHOULD KNOW ABOUT TEAM SPORTS ACTIVITIES AND THIS FORM

ENCLOSE CHECK OR MONEY ORDER AND MAIL TO:

Maryland Senior Olympics c/o Holiday Park Senior Center | 3950 Ferrara Drive | Wheaton, Maryland 20906

Fully complete the Team Roster Form on the next page. Incomplete entries will be returned.

MEDICAL INFORMATIONAthletes, please list on the line below or attach a summary of all medical conditions, allergies, surgeries, medications, etc.

LIABILITY WAIVERThe Maryland Senior Olympics Commission LTD strongly recommends that participants consult their physicians regarding practice, preparation, and competition in the Senior Olympics program. You must read and sign the following in order to participate in the Maryland Senior Olympics:

I, the undersigned participant, shall and will save and keep harmless and indemnify the Maryland Senior Olympics Commission LTD, Montgomery County and all other sponsors, volunteers or any of their agents or employees from and against any and all liability and claims which I may have and/or persons through me may have, such as a spouse or children, for damages of any kind or nature, including but not limited to personal injuries or death caused in whole or in part by the negligent acts of omission or commission by said indemnities acting independently or jointly in the sponsorship, conduct or operation of the 2016 Maryland Senior Olympics.

I have prepared myself for the event(s) which I have entered by practicing prior to the Maryland Senior Olympics. To the best of my knowledge and belief, I have no physical restrictions which would prohibit my participation in the events that

I have selected. The Maryland Senior Olympics Commissions LTD has my permission to have a physician attend me if deemed necessary during my participation in the Maryland Senior Olympics.

I have read and understand all the information contained in the official form and the Risk Criteria as listed in the Mary- land Senior Olympics registration form, which must be met in order to compete in the 2016 Maryland Senior Olympics. Fraudulent statements on this application will result in disqualification.

The Maryland Senior Olympics Commission LTD reserves the right to photograph participants for publicity purposes.

SIGNATURE OF PARTICIPANT: DATE:

FULLY COMPLETE THE TEAM ROSTER FORM ON THE NEXT PAGE

2017 TEAM REGISTRATION FORMSNEW PARTICIPANTS MUST ENCLOSE A COPY OF A VALID DRIVER’S LICENSE OR MVA IDENTIFICATION.

n Completely fill out the roster form on the next page and please print clearly or attach separate typed list;

n Even though you might be entered in an individual sport, you must still be on a team roster to be eligible to play;

n Be sure to choose which sport your team is entering, the age group and the sex;

n List your medical information. Use an extra piece of paper, if necessary. This data is for your safety in case of emergency;

n Make sure the captain has read and signed the Liability Waiver, and that his/her players are aware of the agreement.

n The deadline for entry is two weeks prior to your event.

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Kids run too! Cotton T-shirt with each Fun-Run registration.

After-race expo with free food, beverages, and samplings from

our many vendors!*This is a qualifying

run for the Maryland Senior Olympics.

Visit us for more information and sign up atkentlandsfoundation.org/annual-5k

24th annual Kentlands/Lakelands 5KIn partnership with the city of Gaithersburg, join over 1000 runners for

the largest 5K event in Montgomery County!

Dri-Fit shirt with every 5K registration!

(Men’s and Women’s sizes)

CASH PRIZES to top 3 male

and female finishersSaturday

September 2, 20178 am Kid’s Run, 8:30 am 5K

Kentlands Market Square Plaza

This USATF-certified 10K course, as well as the 5K course, travel through the beautifulMt. Washington neighborhood and include rolling hills. Participant amenities include

professional chip timing, a long-sleeved technical shirt and a catered post-race party. All proceeds benefit the Herman & Walter Samuelson Children’s Hospital at Sinai.

raceforourkids.org

5K and 10K Races Sunday, September 17, 2017

SPO

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(CIR

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ON

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BA

SKET

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LL $

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ALL

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PRSRT STD

US POSTAGE PAID PERMIT NO. 6439 SUBURBAN, MD

MARYLAND SENIOR OLYMPICS 3950 FERRARA DRIVE WHEATON, MD. 20906

Birmingham, Alabama - June 2-15, 2017

Must be 50 years of age or older by December 31, 2016.Qualify through a NSGA sanctioned State Senior Games in 2016.

Sports O�ered

National Senior Games

1987-2017

www.NSGA.com

2017 National Senior Gamespresented by Humana

Archery - Badminton - Basketball - Bowling - Non-Ambulatory Bowling - Cycling - Golf - Horseshoes - Non-Ambulatory Horseshoes Pickleball - Race Walk - Racquetball - Road Race - Shu�eboard Non-Ambulatory Shu�eboard - Softball - Swimming - Table Tennis

Tennis - Track & Field - Triathlon - Volleyball

For more information225-706-5101

[email protected]

Documents

2017 INFORMATION & REGISTRATION GUIDE · PDF fileto participate is to win! information & registration guide proudly sponsored by 2017 mdseniorolympics.org