Return form in person or mail to: Town of Cutler Bay Parks Department. Attn: Janelle Marzouka, 10720 Caribbean Blvd. Sui
Parks and Recreation Department Cutler Bay Senior Games October 16-20, 2017 REGISTRATION FORM Name: Date of Birth
Age
Sex
M
F
T-Shirt Size
Age Category (Please Circle)
50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84, 85-89, 90-94
Address Street
Phone:
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City
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Zip Code
E-mail Address:
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Emergency Contact:
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Area Code
GENERAL AGREEMENT / RELEASE In consideration for the Town of Cutler Bay providing the requested activity, I, the undersigned do hereby: 1) Assume all risk of possible damage or injury through my participation in this Town of Cutler Bay activity. 2) Agree to compensate the Town of Cutler Bay for any repair and/or replacement costs for damages to the facility or equipment as a result of my misuse of the equipment. 3) Agree to indemnify and hold harmless the Town of Cutler Bay and/or its departments, agents or employees from any and all liability, claims, suits, losses, damages including attorney’s fees at the trial and appellate court level, paralegal fees and investigative costs for injury to person or property arising out of my participation in the requested program. 4) Understand and agree to abide by all applicable rules and regulations as set forth herein and attached to this form. I further understand that I may be asked to vacate the premises and may forfeit my participation fee if I fail to abide by these rules and regulations or any other reasonable request from the Town of Cutler Bay staff. 5) I certify that the above information is correct and that I have read and understand the rules and regulations governing this activity.
Signature
Date
Entry Form - *Registration Deadline is Monday, September 25, 2017*
1. Please check the event(s) you wish to enter 2. Please note partners where requested. Partners must complete separate entry form
Tennis Singles Doubles
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Mixed Doubles
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Basketball Shooting Billiards Bowling Pickleball Singles Doubles
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Mixed Doubles
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Shuffleboard Singles Doubles
Swimming 200Y 50Y 100Y 100Y 100Y 50Y 200Y 50Y 100Y 50Y 200Y 100Y 200Y 500Y
Freestyle Backstroke Breaststroke Butterfly Individual Medley Breaststroke Breaststroke Freestyle Backstroke Butterfly Individual Medley Freestyle Backstroke Freestyle
Table Tennis
Return form in person or mail to: Town of Cutler Bay Parks Department Attn: Janelle Marzouka, 10720 Caribbean Blvd. Suite 105 Cutler Bay, FL 33189 or via e-mail:
[email protected] 