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2017 Summer Games Registration Form

District #19 Brampton, North Peel & Dufferin

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Chinguacousy Park 9050 Bramalea Road

REGISTRATION LOCATIONS Knightsbridge Com. & Sr. Citizens’ Centre: 1 A Knightsbridge Rd. 905-792-7422. Flower City Seniors’ Rec. Centre: 8870 McLaughlin Rd. 905-874-3500 Fees are payable by Cash, Debit, VISA, MC or a cheque made payable to “City of Brampton”. Note: ALL FEES ARE NON-REFUNDABLE

Eligibility rules and rules of play for all events are found on the OSGA website: www.osga55plus.ca A false statement may lead to disqualification from all competition now and in the future.

Andrews Community

Funeral Centre Parkinson Bus Lines

Brampton

Chapter 52 Brampton

Name: OSGA #: Renewal New

Address: Female Male

City: Postal Code: Year of Birth:

Telephone: ( ) E-Mail:

Note: Registrants must be 55 years of age or older by December 31, 2017.

You must register at least 1 week prior to the event!

All information is strictly confidential and will not be shared with any agency other than the OSGA office as necessary.

DISTRICT #19 SPONSORS

THE ONTARIO SENIOR GAMES ASSOCIATION RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT (For Participants)

WARNING! By signing this document, you will waive certain legal rights. Please read carefully 1. This is a binding legal agreement; therefore, clarify any questions or concerns before signing. As a participant in the

activities, programs and events of the Ontario Senior Games Association (collectively the “Activities”), the undersigned acknowledges and agrees to the following terms:

Disclaimer 2. The Ontario Senior Games Association, and its directors, officers, members, employees, coaches, volunteers, officials,

participants, agents, sponsors, organizers, districts, and representatives, in addition to the Province of Ontario, all municipalities within the OSGA designated District, (the “Organizations”) are not responsible for any injury, property damage, expense, loss of income, damage or loss of any kind suffered by a participant or volunteer during, or as a result of, the Activities, caused in any manner whatsoever including, but not limited to, the negligence of the Organizations.

Description of Risks

I have read and agree to be bound by paragraphs 1 and 2

3. I am aware that the Activities which I am entering, may be extremely difficult and hazardous even for well-conditioned athletes under the most favorable conditions.

4. I am participating voluntarily in the Activities. In consideration of my participation, I hereby acknowledge that I am aware of the risks, dangers and hazards associated with or related to the Activities. The risks, dangers and hazards include, but are not limited to, injuries from: a) The risks, dangers and hazards particular to the Activities in which I am participating; b) Exerting and stretching various muscle groups; c) Vigorous physical exertion, strenuous cardiovascular workouts and rapid movements; d) Failing to play safely or within one’s ability or to remain with designated areas; e) Physical contact with other people; f) Failure to properly use any piece of equipment or from the mechanical failure of any piece of equipment; g) Failing to comply with the rules established for participation; h) Falling, tumbling or hitting other surfaces; i) Falling to the ground due to uneven, slippery or irregular surfaces; j) Contacting, colliding or being struck by other individuals, equipment, stands, or benches; k) Extreme conditions which may result in heatstroke, hypothermia, heart attack, stroke, dehydration or any other condition

that results from being exhausted; or Agreement to Terms and Release of Liability 5. In consideration of the Organizations allowing me to participate, I agree:

a) That my physical condition has been verified by a medical doctor to participate in the Activities and no medical condition will be worsened by my participation in the Activities;

b) That I have trained adequately for the Activities; c) That the sole responsibility for my safety remains with me; d) To remove myself if I sense or observe any unusual hazard or unsafe condition; or feel unable or unfit to safely continue; e) To ASSUME all risks arising out of, associated with, or related to, my participation; f) To WAIVE any and all claims that I may have against the Organizations now or in the future; g) To freely ACCEPT AND FULLY ASSUME all such risks and possibility of personal injury, death, property damage,

expense and related loss, including loss of income, resulting from my participation in the activities, events, and programs of the Organizations; and

h) To FOREVER RELEASE the Organizations from any and all liability for any and all claims, demands, actions, damages (including direct, indirect, special and/or consequential), losses, actions, judgments, and costs (including legal fees) (collectively, the “Claims”) which I may have now or in the future, that might arise out of, result from, or relate to my participation in the Activities, even though such Claims may have been caused by any manner whatsoever, including but not limited to, the negligence, gross negligence, negligent rescue, omissions, carelessness, breach of contract and/or breach of any statutory duty of care of the Organizations.

I have read and agree to be bound by paragraphs 3-5 Acknowledgment

6. I acknowledge that I have read this agreement and understand it, that I have executed this agreement voluntarily, and that this agreement is to be binding upon myself, my heirs, spouse, children, parents, guardians, next of kin, executors, administrators and legal or personal representatives.

Signature of Participant Printed Name of Participant District Date

CONSENT FOR MEDICAL TREATMENT (Participants and Volunteers 18 and over)

I, (name of participant), give permission to the Ontario Senior Games Association to make decisions concerning medical care and treatment, and where necessary to authorize such care and treatment.

I understand that the Ontario Senior Games Association will make every reasonable effort, in the circumstances, to contact _ (Contact) at (telephone) regarding my medical status in the event medical care or treatment is required. In the event that (Contact) cannot be contacted, I hereby give my permission to the licensed physician, dentist, athletic therapist, nurse or other medical professional whose services might be required to provide medical care and treatment,

By signing here, I indicate that I have the understanding and capacity to communicate health care directives for my myself and that I am fully informed as to the contents of this document and understand the full import of this grant of powers to the Ontario Senior Games Association.

Date: Signature of Participant:

Witness:

IMAGE CONSENT FORM AND RELEASE

1. I hereby grant to the Ontario Senior Games Association and its agents on a worldwide basis, the permission to take, use and copyright in their own name photographs, videotapes, digital and video images, films, voice recordings or any other likeness of me (collectively the “Images”), to use, transmit, publish and sell such Images, in any format, style, form or media. This consent will remain in effect in perpetuity.

2. I further agree that all Images, plates, negatives and masters relating to the foregoing will be owned by the

Ontario Senior Games Association.

3. I hereby fully release, discharge, and agree to save harmless the Ontario Senior Games Association, for any and all claims, demands, actions, damages, losses or costs that might arise out of the collection, use or disclosure of the Images or taking, publication, sale, distortion of the Images, plates, negatives, and masters or any other likeness or representation of me that may occur or be produced in the taking of said Images or in any subsequent processing thereof, including without limitation any claims for libel, passing off, misappropriate of personality or invasion of privacy.

4. I UNDERSTAND AND AGREE, that I have read and understood the terms and conditions of this document. On

behalf of me, my heirs and assigns, I agree that I am signing this document voluntarily and to abide by such terms and conditions.

Signed at this _ day of , 20 .

Print Name of Participant:

Signature of Participant: District

2017 Summer Games Registration Form

District #19 Brampton, North Peel &

DufferinDISTRICT 19 REGULATI ONS FOR PARTICIPATION IN THE ONTARIO 55 + GAMES

Selection of qualified representatives. 1) Competitions held at District 19 Summer and Winter Games will determine a winner{s} in all individual and team events. The first-place

finisher{s} will be invited to participate at the Ontario Games if held that year. If the first place (gold medal) winner{s} is unable to attend,the second place (silver medal) finisher{s} will be invited, then third place, fourth place and so on in order of finish, until the required number of individuals has been selected. Winners may qualify for the Regional Games, if held that year.

2) If a competition for any event cannot be held due to insufficient numbers or an unsatisfactory venue (e.g. rained out), volunteer candidates having a

valid OSGA card with current District 19 membership, will be accepted as district representatives.

ADDITIONAL INFORMATION:

DISTRICT COORDINATOR – GEORGE SHEPPERDLEY at 905-872-2138 | E-Mail at she pp@roge rs .c om

DEPUTY DISTRICT COORDINATOR –JOE FERRARI at 647-205-6439 | E-Mail at j o e. f er r a r i@a cco .co m

VENUE INFORMATION

Alloa Public School 1248 Mayfield Road Gore Bocce Club 9916 The Gore Road

Brampton Bowling Centre 12 Beech Street Loafer’s Lake Rec. Cent. 30 Loafer’s Lake Lane

Brampton Tennis Club 38 Union Street Mayfield Golf Course 12552 Torbram Road

Chinguacousy Park 9050 Bramalea Road McMurchy Recreation Centre 247 McMurchy Avenue S.

Flower City Lawn Bowling Facility 8810 McLaughlin Road Royal Canadian Legion 80 Mary Street Flower City Seniors Rec. Centre 8870 McLaughlin Road Gore Meadows Com. Centre 10150 The Gore Road

CHECK all events you wish to enter and complete ALL needed information re: level, partners & averages. Your partner(s)/team members MUST complete their own registration form.

Events & Location Men Women Date & Time Special Notes

8-BALL ** Loafer’s Lake Recreation Centre

55+ 842558 55+ 842562 Mon., May 29th

9:30 a.m.

BID EUCHRE (Doubles)** Flower City Seniors Recreation Centre

Open Pairs 842587 Thu., May 11th

6:30 p.m. Partner:

BOCCE ** (Doubles) Gore Bocce Club

Open Pairs 842588 Sat., May 6th

9:30 a.m. Partner:

CARPET BOWLING (Doubles)** Flower City Seniors Recreation Centre

Open Pairs 842618 Wed., May 17th

9:00 a.m. Partner:

CONTRACT BRIDGE (Doubles)** Flower City Seniors Recreation Centre

Open Pairs 842620 Mon., May 8th

1:00 p.m. Partner:

CRIBBAGE (Doubles)** Flower City Seniors Recreation Centre

Open Pairs 842622 Thurs., May 25th

6:30 p.m. Partner:

CYCLING (10 km Time Trial)** Alloa Public School

55+ 842626 65+ 842627

55+ 842631 65+ 842633 Sun., May 14th

9:00 a.m. Rain Date: TBA

CYCLING (5 Km Prediction)** Alloa Public School

55+ 842636 55+ 842637

DARTS (Doubles)** Royal Canadian Legion

Men 842639 Women 842560 Wed., May 10th 1:00 p.m.

Partner:

Mix. Partner: Mixed 842640

EUCHRE (Doubles)** Flower City Seniors Recreation Centre

Open Pairs 842641 Tue., May 2nd

1:00 p.m. Partner:

FIVE KM PREDICTION RUN**Terry Fox Stadium

Men 842642 Women 842643 Tues., May 23rd

10:00 a.m.

FIVE PIN BOWLING ** (Open Team of 5) Brampton Bowling Centre

Team 842644

1.

2.

3.

4.

Mon., May 8th 9:00 a.m.

Place me on a team

League Average{s}: Name of League(s): (If applicable)

Lane Fees: $14.00 inc. HST Shoe Rental: $1.25 inc HST To be paid at bowling centre.

FIVE PIN BOWLING (Singles) ** Brampton Bowling Centre

Men 842645 Women 842646 Mon., May 1st

9:00 a.m.

2017 Summer Games Registration Form

District #19 Brampton, North Peel &

Dufferin

FLOOR SHUFFLEBOARD (DOUBLES)** Flower City Seniors Recreation Centre

Open Pairs 842647 Wed., May 31st

9:00 a.m. Partner:

GOLF - CALLAWAY ** MAYFIELD GOLF COURSE PARTNERS: 1.2.3.

Men 55+ 842648 Women 55+ 842651

Men 65+ 842649 Women 65+ 842652

Men 75+ 842650 Women 75+ 842653

Wed., May 24th 10:00 a.m.

Place me in a group

Golf Package: $53.05 (includes green fees, cart rental, boxed lunch, HST) To be paid at golf clubhouse. Rain Date: TBA

LAWN BOWLING (MIXED DOUBLES &TRIPLES)** FLOWER CITY LAWN BOWLING FACILITY

Partner(s) 1. ________________________

2. ____________________________

Mix Pairs 842654 Mix Triples 842655

Sat., June 3rd 9:00 a.m.

One female required per team. Rain Date: TBA

MINI-PUTT GOLF (DOUBLES) CHINGUACOUSY PARK

Men 842656 Women 842658

Mixed 842659 Partner: _____________

Fri., June 2nd 1:00 p.m.

Partner: ____________________ Golf Fees: $3.90 To be paid at Mini-Golf Centre. Rain Date: TBA

NORDIC WALKING (Prediction)** Terry Fox Stadium

55+ 1 Km 842660 55+ 3 Km 842661

55+ 1 Km 842662 55+ 3 Km 842663

Tues., May 23rd 8:30 a.m.

PICKLEBALL (Doubles)** Flower City Seniors Recreation Centre

Men 55+ 842848 Men 65+ 842849

Men 75+ 858209

Women 55+ 842840 Women 65+ 842847 Women 75+ 858208 Sat., May 13th

9:00 a.m.

Partner: ______________________

Mixed Partner: ______________________ Mixed 55+ 842850

Mixed 65+ 842851

Mixed 75+ 858210

SNOOKER ** Flower City Seniors Recreation Centre

Men 55+ 842853 Women 55+ 842852 Mon., May 15th

9:30 a.m.

SWEEP Gore Meadows C. C., Rm. #2

Open pairs 842854 Partner: ________________________

Thurs., May 25th 1:00 p.m.

10150 The Gore Road, north of Castlemore Road

SWIMMING (Prediction)** McMurchy Recreation Centre

55+ (200 m) 842862 65+ (100 m) 842870

55+ (200 m) 842859 65+ (100 m) 842866

Tues., May 9th 1:30 p.m.

SWIMMING (Sprint)** (best 3 0f 4 strokes) McMurchy Recreation Centre

55+ (50 m) 842879 65+ (25 m) 842885 75+ (25 m) 842887

55+ (50 m) 842875 65+ (25 m) 842877 75+ (25 m) 842878

TENNIS (Doubles)** Brampton Tennis Club

men 55+ 842970 men 65+ 842974 men 75+ 842976

women 55+ 842966 women 65+ 842968 women 75+ 842969

Women: Fri., May 26th 1:00 p.m.

Men: Sat., May 27th 1:00 p.m.

Partner: ______________________

MIxed Partner: ______________________ Rain Dates: TBD

Mixed 55+ 842977 Mixed 75+ 842982 Mixed 65+ 842980

Sun., May 28th 9:00 a.m.

WALKING (Prediction)** Terry Fox Stadium

55+ 3 Km 842893 75+ 1.6 Km 842894

55+ 3 Km 842892 75+ 1.6 Km 842891

Tues., May 23rd 8:30 a.m.

NOTES: Fees are charged to cover the cost of insurance, equipment and awards necessary to run these games. Events will be cancelled where convenors and qualified officials are unable/unwilling to volunteer. 55+ Games committee members, convenors and officials are volunteers and not paid for their services.

Entry Fees: $2.00 per event $ 10.00 OSGA Annual Membership Fee: $10.00 Valid: April 1st, 2017 – March 31st, 2018

841158 $ 10.00

TOTAL $ 10.00

**Medal winners qualify for the OSGA South Central Regional Games, Hamilton, Aug. 29, 2017

Remember the annual banquet in 2018! Date to be announced.