LOCAL EVENT QUALIFIER
for the State Level
PRESENTED BY:
SENIOR GAMES BY THE SEA
2017 ENTRY PACKET
Athletic Events held April 17th thru May 15th
Silver Arts Events held May 19th & May 22nd - 28th
2017 Coordinating Agencies
Community Services - Recreation Division
NEW HANOVER COUNTY
SENIOR RESOURCE CENTER
Wilmington Art
Association
Senior Games by the Sea is sanctioned by North Carolina Senior Games, Inc.
NCSG, Inc. is sponsored statewide by the North Carolina Division of Aging and Adult Services
SilverArts
SCHEDULE OF EVENTS
Thursday, April 27
Online/Paper Entry deadline for all Silver Arts (5pm)
Literary Arts Submission
10:00am-5:00pm
YMCA
Friday, May 19
Performing Arts Competition with hors d’oeuvres
6:00pm-8:00pm
Plantation Village
Monday, May 22
2D and 3D Visual and Heritage Arts Submission/Drop Off
10:00am-3:00pm
the ArtWorkstm
Thursday, May 25
Artist GALA & Award Ceremony
5:30pm-8:00pm
the ArtWorkstm
Friday, May 26—Saturday, May 27
Silver Arts Public Viewing & Sale
10:00am-4:00pm
the ArtWorkstm
Sunday, May 28
Artists pick up their entries
11:00am-2:00pm
the ArtWorkstm
ALL ARTISTS & ATHLETES
ARE INVITED TO ATTEND…
Opening Ceremony 4/17
Silver Stride Fun Walk 4/27
Performing Arts & Follies Showcase 5/19
Silver Arts Public Viewing & Sale 5/26 - 5/27
events are hosted by
Athletics
Monday, April 17
OPENING CEREMONIES 9am
Hoggard HS Track
Monday, April 17
100 Meter Dash
9am-11am
Hoggard HS Track
200 Meter Dash
9am-11am
Hoggard HS Track
400 Meter Dash
9am-11am
Hoggard HS Track
800 Meter Dash
9am-11am
Hoggard HS Track
1500 Meter Run
9am-11am
Hoggard HS Track
1500 Meter Race Walk 9am-11am
Hoggard HS Track
Tuesday, April 18
5K Race Walk
9am-11am
Hoggard HS Track
Discus
9am-11am
Hoggard HS Track
Shot Put
9am-11am
Hoggard HS Track
Running Long Jump
9am-11am
Hoggard HS Track
Standing Long Jump
9am-11am
Hoggard HS Track
Friday, April 21
Table Tennis
9am-11am
Senior Center
Tuesday, April 25
Tennis
10am-12pm
Empie Park
Wednesday, April 26
Cycling 1 Mile
9am-Noon
Brunswick County
Cycling 5K
9am-Noon
Brunswick County
Cycling 10K
9am-Noon
Brunswick County
Cycling Events are held at Northwest District Park, Hwy 74/67
Friday, April 28
Basketball Shoot
11:00am
YMCA Gym
Basketball Tournament 11:30am
YMCA Gym
Saturday, April 29
Swimming (all events) 1pm-3pm Plantation Village
Tuesday, April 25
Corn Hole
10am-12pm
Empie Park
Football Throw
10am-12pm
Empie Park
Softball Toss
10am-12pm
Empie Park
Bocce Ball
10am-12pm
Empie Park
Shuffleboard (Singles) 10am-12pm
Empie Park
Shuffleboard (mixd dbls) 10am-12pm
Empie Park
Horseshoes (singles)
10am-12pm
Empie Park
Horseshoes (mixed dbls) 10am-12pm
Empie Park
Silver Stride Fun Walk 10am-12pm
Empie Park
Wednesday, May 3
Golf
9am
Municipal Course
Thursday, May 4
Billiards
9am
10 Pin Alley
Friday, May 5
Pickleball - All Events
10am-1pm
Midtown YMCA
Tuesday, May 9
Softball Tournament
10am
Olsen Park
Wednesday, May 10
Bowling - Singles
1pm
Cardinal Lanes
Monday, May 15
Bowling - Doubles
1pm
Cardinal Lanes
Bowling - Mixed Doubles3pm
Cardinal Lanes
Saturday, May 20
5k Run
8am
EmergeOrtho 5k
GENERAL INFORMATION
Eligibility: All participants must be 50 years of age or older by December 31, 2017 and a North Carolina resident
for a minimum of three consecutive months of the year. An Official Entry Form must be completed and submitted
by April 27th for athletic events and Silver Arts. See event list for individual event deadlines. Personal data,
events entered and a signed and dated waiver must be submitted with a check covering all fees. Bowling and
golf fees will be collected at the event site on the day of the event. Partners, team members, performing artists and
accompanists must be registered participants.
Confirmation: Participants will receive a confirmation letter or email (preferred) confirming events entered.
Unsanctioned Activities: See Unsanctioned Activities Schedule in the registration packet for list of events,
scheduled times and venues. The Sports Event Registration Form in the packet must be completed and turned in
with the Official Entry Form. Unsanctioned Activities are not eligible for State Finals. Note: Unsanctioned Activities are included when counting the # of events entered.
SILVER ARTS INFORMATION
All Silver Arts Entries :
 Must be the artist’s own creation and not part of a manufactured kit. Artists (except literary) must submit originals, not prints. If special display equipment is necessary, artist shall provide equipment.
 Will not be accepted if entry has been entered in a previous Silver Arts show.
 Must be created after the age of 50 and within two (2) years of the Silver Arts 2017 exhibit date.
Check the appropriate category/sub-category for your art piece or act. Complete all information about your entry
(title, size etc.) and verify it meets all applicable requirements. Performing Artists must provide an introduction statement for their act to be read by the Master of Ceremonies.
Judges will choose first-, second- and third-place winners in each sub-category of Visual, Heritage, Performing and
Literary Arts. First-, second- and third-place winners in Visual and Heritage Arts are eligible to attend State Finals
(only one entry per sub-category). First- and second-place winners in Literary Arts and the overall winner of Performing Arts are eligible for State Finals. Winners must register for State Games separately. There is no obligation for winners to attend State Games and cost of participation is up to the individual winners. State Games
registration forms are available at www.ncseniorgames.org and at the YMCA Sports Office following the completion
of the Senior Games By The Sea events.
SILVER ARTS SALE INFORMATION—PLEASE READ!!
Should you elect to sell your entry piece or additional Bin Work, please note that the Senior Games By The Sea
does not receive any portion of the proceeds from the sale of any entry piece. The choice to sell your entry is completely up to you, the artist. The Wilmington Art Association acts as broker between buyer and seller and receives
20% commission on each sale, subtracted from the sale price.
BIN WORK—2D AND 3D
2D artists may submit up to 10 pieces of bin work at NO ADDITIONAL COST.
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Work on paper must be matted.
All 2D bin work must be shrink-wrapped or in artist’s plastic sleeve & have mat-board or foam core backing - absolutely
no corrugated cardboard. Framed bin work is not allowed.
 Maximum size, including mat, must not exceed 24” in either direction.
 Bin work must have a label attached to the upper right front side. The label should include: artist’s name, phone number,
title, medium, price; and ORIGINAL or REPRODUCTION.
We reserve the right to mix bin work of several artists within one bin if space becomes a problem. Members are asked to bring
a standard black/canvas bin to share if necessary. Artist’s name should be adhered to the underside of the bin for identification.
3D artists may submit up to 5 additional pieces to display as “3D bin” work other than the 5 pieces of sculptures entered into SilverArts show.
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The 5 extra pieces together may NOT exceed a space of 12”. These 5 additional pieces will be exhibited separately from
your 5 pieces entered into the SilverArts Show. Only 3D that is for sale will be accepted for this exhibition and sale. All 3D
work must be labeled with artist’s name, medium, title (if applicable) and price.
NOTE: 2D Artists if you are bringing 10 “bin work” and 3D artists if you are bringing 5 sculptures considered your
“bin work” YOU must inventory your creations on a 4”x6” index card and that must be turned into the receiving committee with your name, phone number, title, medium and price.
SPORTS GENERAL INFORMATION
Bowling and Golf Facility Fees: An additional facility fee must be paid directly to the bowling facility ($5) and/or golf facility
($35) on the date of the event. Golf participants must meet a Minimum Performance Score (MPS) and finish first, second, or
third in their age group to qualify for State Finals. MPS and rules are available from the event manager and on the NCSG website: www.ncseniorgames.org.
Cycling: The Cycling event will be held at the Brunswick County Northwest District Park.
Table Tennis: Participants should wear solid colored clothing. No white or multi-colored clothing is allowed.
Team Sports: The age of a team is determined by the age of the youngest team member. A player may compete on only one
team per sport. See NCSG Rules Book for age categories per sport and number of players. Each team must have a designated Team Captain and Team Name. Rules for all sporting events can be found at www.ncseniorgames.org.
Partners: Each participant is responsible for choosing his/her own partner and recording partner’s name on the Official Entry
Form. Partners must be registered participants, no exceptions!
Tennis: A $2 per event fee must be paid as part of the registration process to cover the cost of balls.
Swimming: Participants are limited to 6 swimming events.
Race Walking Events: Participants must wear clothing that leaves the knees exposed.
Check-In: In all events, participants must arrive at the event site 15 minutes before the event begins and check in with the
event manager. Participants in open events must check in with the event manager during the designated event time.
Open events are: basketball shoot, football throw, softball throw, discus, running long jump, standing long jump, shot put, Corn
Hole, and Silverstriders Fun Walk. It is the participant’s responsibility to know and understand the rules of each sport in which
they participate.
Rain Dates: In the event of bad weather, participants in Sanctioned Events should report to the event site for information on
rescheduling. Senior Games staff will attempt to contact all event participants via email only. Rain dates will be announced the
day of the event at the site. Unsanctioned activities will not be rescheduled.
STATE FINALS INFORMATION
Date: Senior Games State Finals competition will be held in the fall of 2017.
Qualification: It is the participant’s responsibility to check with his/her Local Senior Games Coordinator to determine qualification for State Finals and to get a State Finals Entry Packet. (Available on the NCSG web site: www.ncseniorgames.org).
 Athletes who win first, second, and third places in sanctioned sports events are eligible to participate.
 SilverArts participants who win first, second and third places in Visual or Heritage Arts are eligible to participate in the State
Finals. Visual and Heritage Arts winners may enter only one entry per sub-category.
 1st- and 2nd-place winners of Literary Arts and the over-all winner(s) of Performing Arts are eligible for State Finals.
To Register for State Finals:
 All eligible State Finals participants must complete a State Finals Official Entry Form and submit it to the North Carolina
Senior Games office in Raleigh by 5 p.m. on August 1, 2017. August 1, 2017 is the absolute deadline. There will be no
exceptions. The deadline for Early Bird registration is July 1, 2017. A photo ID will be required for State Finals registration check-in at every activity every day.
 All SilverArts winners will submit an additional SilverArts Information Form with their Official Entry Form.
 State Finals Entry Forms will NOT be mailed to you or for you to the State Games office.
 It is your responsibility to obtain and submit the required forms for State Finals.
Forms: State Finals Official Entry Forms will be available at the Express YMCA in the Healthy Living Office, 11 S. Kerr Ave,
Wilmington, NC 28403 and on the NCSG website: www.ncseniorgames.org Participants are encouraged to register
online! www.torch.ncseniorgames.org
Qualified Participant must be a North Carolina resident for a minimum of three (3) consecutive months of the year.
OFFICIAL ENTRY FORM—SILVERARTS 2017
VISUAL ARTS CATEGORY
Deadline to register is April 27
NAME: _____________________________________________Phone #________________________________
VISUAL ARTS CATEGORY: Sub-categories are: Acrylics, Drawing, Pastels, Photography, Oil, Sculpture, Watercolor and Mixed Media. Artist may enter a maximum of five (5) pieces into competition with no more than
three (3) entries per sub-category. (Example: 1 oil, 3 photography, 1 mixed media = 5 pieces)
There is a 20% commission on sales if you choose to sell your art pieces. If you choose not to sell artwork, please
write “NFS” (Not For Sale) on the price line. Artists may bring an additional 10 pieces of “Bin Work” for sale.
Indicate if you will bringing additional Bin Work to sell: YES ____ NO ___
See shaded section of inside cover page for details.
Title
1._____________________________________Sub-category _________________________ Size _______________ Price: $__________
2._____________________________________Sub-category _________________________ Size _______________ Price: $__________
3._____________________________________Sub-category _________________________ Size _______________ Price: $__________
4._____________________________________Sub-category _________________________ Size _______________ Price: $__________
5.______________________________________Sub-category _________________________ Size _______________ Price: $__________
VISUAL ARTS GUIDELINES
ALSO AVAILABLE AT WWW.NCSENIORGAMES.ORG
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All artwork, except sculpture, must be framed, securely wired, and ready to be hung (no serrated hooks or
string). Artwork, except sculpture, not properly wired will not be displayed.
Artwork, except sculpture, can be no larger than 36" x 42", including matting and frame.
Entries can be no heavier than 50 pounds.
Sculpture groupings (sets) may have no more than 3 pieces per grouping (set).
Mixed media may be a freestanding piece.
Freestanding entries must be able to be displayed in an area 3' (W) x 3' (L) x 5' (height).
Artists, or their representatives, are responsible to deliver and pick-up their entry at/during the designated
times.
If on-site assembly is required, details must be specified on the Information Form for NCSG prior approval.
The art piece must be an original work, not a print. Artist's name, phone #, title of entry, and medium must
appear on, or be attached to entry for identification.
Photos cannot be returned.
SilverArts Registration Checklist
Complete and return Personal Data Form (required for all participants in Senior Games).
Complete and return SilverArts Category Entry Form (the form above).
Did you include your payment? Registrations are incomplete unless paid in full.
Keep the Schedule of Events for your reference.
OFFICIAL ENTRY FORM—SILVERARTS 2017
HERITAGE ARTS CATEGORY
Deadline to register is April 27
NAME: _____________________________________________Phone #________________________________
HERITAGE ARTS CATEGORY: Sub-categories are: Basket Weaving, China Painting, Jewelry, Knitting, Needlework, Pottery (thrown or hand built), Stained Glass, Tole/Decorative Painting, Wood Carving, Woodworking and
Woodturning, Quilting (hand or machine).
There is a 20% commission on sales if you choose to sell your art pieces. If you choose not to sell artwork, please
write “NFS” (Not For Sale) on the price line. Artists may bring an additional 5 pieces of “Bin Work” for sale.
Indicate if you will bringing additional Bin Work to sell: YES ____ NO ___
See shaded section of inside cover page for details.
Title
1._____________________________________Sub-category _________________________ Size _______________ Price: $__________
2._____________________________________Sub-category _________________________ Size _______________ Price: $__________
3._____________________________________Sub-category _________________________ Size _______________ Price: $__________
4._____________________________________Sub-category _________________________ Size _______________ Price: $__________
5._____________________________________ Sub-category _________________________ Size _______________ Price: $__________
HERITAGE GUIDELINES
ALSO AVAILABLE AT WWW.NCSENIORGAMES.ORG
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Artist must supply special display equipment.
Artist may enter a maximum of five (5) pieces with no more than three (3) entries per subcategory
(Example: 3 pieces of Pottery, 2 pieces of jewelry = 5 pieces)
Entries must be the original work of the individual and not a group.
Pottery must be hand built or thrown.
Latch hook rugs and pieces from ceramic molds will not be accepted.
All framed work must be securely wired, ready to be hung (no serrated hooks or string). Two dimensional work
not properly framed and wired will not be displayed.
Framed works can be no larger than 36" x 42", including frame.
Entries can be no heavier than 50 pounds.
All entries, except framed work, must be able to be displayed in an area 3'(W) x 3'(L) x 5'(Height).
Groupings (sets) shall have no more than 3 separate pieces per set. All objects within each piece of the set
must be contained within or attached to one of the 3 pieces of the set.
Identification must be on the bottom or back of each piece of art work with following information:
Artist's name, Phone #, Title, and Medium
Artists, or their representatives, are responsible to deliver & pick-up their entry at/during the designated Date
and Time
Photos cannot be returned.
SilverArts Registration Checklist
Complete and return Personal Data Form (required for all participants in Senior Games).
Complete and return SilverArts Category Entry Form (the form above).
Did you include your payment? Registrations are incomplete unless paid in full.
Keep the Schedule of Events for your reference.
OFFICIAL ENTRY FORM—SILVERARTS 2017
LITERARY ARTS CATEGORY
Deadline to register is April 27
NAME: ________________________________________Phone #________________________________
LITERARY ARTS CATEGORY. Sub-categories are: Poetry; Short Story (Fiction); Essay; Life Experiences
(autobiography). Artist may enter a maximum of 3 entries per sub-category. (Example: 3 poems, 3 essays, 3 life experiences, 3 short stories.)
Four (4) copies of each literary entry (required) must be attached and submitted by April 27th to the Wilmington Family YMCA Express Y, 11 S. Kerr Ave, with the Official Entry Form.
Title
1. _______________________________________________________________Sub-category _________________________
2. _______________________________________________________________Sub-category _________________________
3. _______________________________________________________________Sub-category _________________________
LITERARY ARTS GUIDELINES
ALSO AVAILABLE AT WWW.NCSENIORGAMES.ORG
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All entries must be typed, double-spaced, on 8-1/2 x 11 paper and have a minimum of 1" margins.
A minimum font size is 10-pt type (preferably "times new roman or arial").
Poems can be no longer than 40 lines.
Short stories, essays, and life experiences can be no longer than 8 pages.
All entries must have a title page, which includes title of entry, sub-category, and name of artist.
For judging purposes, the artist’s name should appear only on the title page. Artist's name must not appear on the content pages.
SilverArts Registration Checklist
Complete and return Personal Data Form (required for all participants in Senior Games).
Complete and return SilverArts Category Entry Form (the form above).
Did you include your payment? Registrations are incomplete unless paid in full.
Keep the Schedule of Events for your reference.
OFFICIAL ENTRY FORM—SILVERARTS 2017
PERFORMING ARTS CATEGORY
Deadline to register is April 27
NAME: _____________________________________________Phone #________________________________
NAME of GROUP/ACT: ______________________________________________________________________
(use a separate sheet if you are entering more than one act/group)
CIRCLE TYPE OF ACT:
Vocal
Dance
Comedy/Drama
Instrumental
Line Dance
IS THE ACT: Solo: ___ Group: ___ NUMBER GROUP MEMBERS: _____
LENGTH OF ACT: _____ Minutes
List names of all performers (group members and/or accompanists). Performers and accompanists must be 50
years or older as of 12/31/2017 and must be registered Senior Games participants.
____________________________________________________________________________________________
____________________________________________________________________________________________
EQUIPMENT REQUESTS: ____ Microphone(s)
____ Chair(s)
_____ CD Player _____ Piano
Give a brief statement to be used as an introduction for your act/group at the performance:
____________________________________________________________________________________________
PERFORMING ARTS GUIDELINES
ALSO AVAILABLE AT WWW.NCSENIORGAMES.ORG
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An artist may only have one (1) entry per size of act in each sub-category.
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Performing entries are limited to three (3) minutes of on-stage time. Exceeding the time limit will result in automatic disqualification. Timing is the performer's responsibility and begins with the first note of music or the
first movement visible to the audience and ends with the exit of the last performer from the stage or final
movement of the act.
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Performing entries may be one of the following: (a) soloists, (b) small groups (2 - 4 performers), or (c) large
groups (5 or more performers). Accompanist(s) will be counted to determine size of act. No one under age
50 as of Dec. 31st will be permitted on stage and an accompanist must be a registered participant.
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All performers for all acts must enter stage right and exit stage left or begin and end on the stage.
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Voice presentations must be a live performance by the artist. Background music can be recorded. Lip synch
is not permitted as a performing art.
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No live animals are allowed, except for service animals.
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Only one piece of music must be on the CD. CD must be submitted with Official Entry Form.
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Only one act/group per Local Game is eligible for State Finals. Artists may enter one entry per size of act.
Accompanists will be counted to determine group size.
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REQUIRED DRESS REHEARSAL: To Be Announced: You will be contacted regarding date and time.
SilverArts Registration Checklist
Complete and return Personal Data Form (required for all participants in Senior Games).
Complete and return SilverArts Category Entry Form (the form above).
Did you include your payment? Registrations are incomplete unless paid in full.
Keep the Schedule of Events for your reference.
OFFICIAL ENTRY FORM—SPORTS EVENTS 2017
NAME: ____________________________________________________Phone: ____________________________
Please Print Clearly
Please indicate ( X ) the events in which you would like to participate. Refer to event schedule for dates, times and event sites. Note limitation on swim, and tournament sports. If you plan to attend State Finals, confirm in advance that your partner is also able to attend.
3v3 BASKETBALL TOURNAMENT
OTHER EVENTS
SOFTBALL TOURNAMENT
Team Name: __________________
_____ Basketball Shoot
Team Name: __________________
_____ Billiards
Team Captain: __________________
_____ Bocce -Singles
Deadline to register for Softball only: May 1
Team Captain: _________________
_____ Bocce -Doubles
PARTNER: _______________________
SWIMMING (limit 6 events)
_____ Bocce -Mixed Doubles
Backstroke
PARTNER: _______________________
___ 50yd ___ 100yd ___ 200yd
_____ Cornhole
Breaststroke
_____ Football Throw
_____ Bowling - Mixed Doubles
___ 50yd ___ 100yd ___ 200yd
_____ Horseshoes –Singles
Butterfly
PARTNER: _______________________
_____ Horseshoes –Doubles
___ 50yd ___ 100yd ___ 200yd
PARTNER: _______________________
Freestyle
BOWLING (Scratch only)
_____ Singles
_____ Bowling - Doubles
PARTNER: _______________________
CYCLING
_____ 1 Mile ____ 5 K _____ 10 K
_____ Horseshoes –Mixed Doubles
PARTNER: _______________________
_____ Shuffleboard -Singles
_____ Shuffleboard –Doubles
FIELD EVENTS
PARTNER: _______________________
_____ Discus
_____ Shuffleboard –Mixed Doubles
_____ Shot Put
PARTNER: _______________________
_____ Running Long Jump
_____ Standing Long Jump
_____ Softball Throw
_____ Table Tennis -Singles
_____ Table Tennis –Doubles
PARTNER: _______________________
GOLF
_____ Table Tennis –Mixed Doubles
_____ Minimum Performance Score
PARTNER: _______________________
required to qualify for State Finals
PICKLEBALL
_____ Singles
PHOTO ID required at all event sites.
NOTE: New ruling allows you to substitute a
partner should the partner you competed with
in our local games not be able to go to State
Finals. The substitute must have qualified
in that event.
_____ Doubles
PARTNER: _______________________
_____ Mixed Doubles
PARTNER: _______________________
___ 50yd ___ 100yd ___ 200yd
___ 500yd
Individual Medley
___ 100yd ___ 200yd
TENNIS
Tennis Rating ______
_____ Singles
_____ Doubles
PARTNER: _______________________
_____ Mixed Doubles
PARTNER: _______________________
TRACK EVENTS
_____ 100 Meter Dash
_____ 200 Meter Dash
_____ 400 Meter Dash
_____ 800 Meter Run
_____ 1500 Meter Race Walk
_____ 1500 Meter Run
_____ 5K Race Walk
_____ 5K Run
_____ Silver Striders Fun Walk
= UNSANCTIONED EVENT
Does not qualify for State Finals.
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REQUIRED PAGE FOR ALL PARTICIPANTS
COMPLETE, SIGN, AND RETURN WITH PAYMENT & THE OFFICIAL ENTRY FORMS FOR YOU PARTICULAR
REGISTRATION FEES
Entry fee includes: SilverArts Events, Sports Events, T-shirt, & Entry to Performing Arts Banquet
PICK YOUR CHOICE:
___ Silver Arts only
____ Sports only
ADDITIONAL T-SHIRTS:
_____ BOTH! (still only $15) Plus amounts below
Please circle sizes:
S
M
L XL XXL
…. $
# Shirts x $10.00 =
15___
$ ______
One tshirt is included with registration fee - but you’re welcome to order extras!
TENNIS FEE:
#Tennis Events ______ x $2 each =
$_______
ADDITITIONAL EVENTS: ADD $3.00 per event over 10 events.
example: 12 events = $19, 14 events = $23
$_______
Up to 10 events and/or arts submissions included with $15 entry fee
Note: Bowling fee is $ 5 per person. Golf fee is $ 35 per golfer, due at event site on day of event.
5k fee is $15 per runner, runners must be pre-registered. 5k runners will be contacted with more info on how to register.
LATE FEE: Registrations submitted after April 27th (except Softball) add $ 5.00 =
Note: Softball Tournament only registration deadline is May 1
All SilverArts forms are due April 27. Literary Arts submissions due April 27.
$ ______
VOLUNTARY DONATION: (All donations are tax deductible)
$ ______
Thank you!
TOTAL AMOUNT ENCLOSED
$
Make checks payable to “Wilmington Family YMCA” Write “Senior Games” in the memo.
PERSONAL DATA
(Please
type or print clearly)
Last Name: __________________________________________ First Name: _____________________________ MI: _________
Tshirt Size: Adult Sizes 50/50 Cotton/Poly Blend, Standard Tshirt.
Available for pickup at the opening ceremony (4/17), during the Performing Arts Show (5/19) & at each event throughout the games.
S
M
L
XL
XXL
No T-Shirt wanted
Address: ____________________________________ City: ______________________ State: NC
Zip_____________
County: ___________________ Phone: _______________ Date of Birth: _____________Age as of 12/31/2017______
Email Address: ____________________________________________________________
Male ____ Female_____
Emergency Contact Name: _____________________________ Phone: _______________________Relationship: __________
Many participants opt out of receiving medals. If you choose to do so, please check here _____. If you opt out of receiving medals,
you will still be recognized, the same as all other winners, at the end of each days competition.
Performing Arts Banquet is on 5/19 at Plantation Village at 6pm. All athletes, artists, and families are invited to
attend! Plantation Village is providing light refreshments and hors d’oeuvre, for planning, please let us know
how many people are coming. # of people: ________
REQUIRED PAGE FOR ALL PARTICIPANTS
WAIVER & LIABILITY RELEASE (REQUIRED)
1. I recognize the risk of injury from the activities in this program is significant, including the potential for permanent disability and death: and, while
particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury to me does exist; and,
2. I knowingly and freely assume all such risks, both known and unknown , even if arising from the negligence of the releasees or others and assume full responsibility for my participation; and,
3. I willingly agree to comply with the stated and customary terms and conditions for participation. If I observe any unusual significant concern in my
readiness for participation and/or in the program itself, I will remove myself from participation and bring such to the attention of the nearest official
immediately; and,
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE the Senior Games by the Sea Advisory Board, its officers, Wilmington Family YMCA, New Hanover County and the City of Wilmington, coordinating agencies and event host facilities,
their officers/officials, agents and/or employees, volunteers, other participants, sponsors, advertisers and if applicable owners and lessors of premises used to conduct the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or
property incident to my involvement or participation in this program, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR
OTHERWISE, to the fullest extent permitted by law.
5. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY AND HOLD HARMLESS all the
above Releasees from any and all liabilities incident to my involvement or participation in this program, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by law. I understand that I may become injured during participation, and I accept the risks inherent with participation.
I understand that it is my responsibility to check with my local Senior Games Coordinator immediately following my local Senior Games to determine
if I qualified for State Finals and to get a State Finals Entry Packet. My State Finals Entry Form with payment and all required items must be received in the NCSG office in Raleigh by 5:00 p.m. on August 1st! I understand that this deadline is strictly enforced in fairness to all and it is my
responsibility to make sure I am registered. I understand that State Finals entry forms will not be mailed to me and it is my responsibility to obtain
my own forms.
I allow Senior Games By The Sea to publicly use, with no compensation, photographs or video recordings of me. I have read this release of liability
and assumption of risk agreement, fully understand its terms, understand that I have given up substantial rights by signing it and sign it freely and
voluntarily without any inducement. I understand and consent to have my medical information available to medical providers during the Games if
necessary.
Signed: __________________________________________________
Date: _______________________
Printed Name: ____________________________________________
HEALTH INFORMATION (Optional)
This health information may be shared with medical providers for your care during the Games.
Do you have trouble hearing? _____
Do you wear a hearing aid? _____
Do you wear glasses? _____ Contacts? _____
Any medical conditions, allergies, or medications that Senior Games by the Sea should know about _________________________________________________________________________________________________________
_________________________________________________________________________________________________________
_________________________________________________________________________________________________________
Please provide this information to help us. It will be kept confidential. Thank you!
My ethnicity: Black or African American____
Asian ____
Native Hawaiian or other Pacific Islander ___
American Indian or Alaska Native ____
Hispanic _____
White _____
Unknown/Refused ____
Please complete all portions of the registration form, as well as the Official Entry form for your
specific athletics or arts events. Mail or drop off WITH PAYMENT by April 27th to the Express Y.
ATHLETICS & ARTS REGISTRATION DEADLINE is APRIL 27th
*Softball Tournament deadline is May 1 (if participating in softball only)
DROP OFF: Express Y Membership Desk, 11 South Kerr Ave., Wilmington, NC 28403
MAIL: Express Y, Attn: Senior Games, 11 S. Kerr Ave Wilmington, NC 28403
OR GO ONLINE AND SKIP THE PAPER: torch.ncseniorgames.org