District #22
Hamilton/Wentworth 55+ Games
2017 Registration Form
Name
City
Postal Code
M
Email
F
Year of Birth
Phone Number
Please fill in all sections above. Please PRINT clearly.
Fees: $10.00 for first event, $3.00 for any additional events, plus any on site fees as marked
with this * symbol. Please  events you are registering in and complete the necessary
information required.
Summer Games Registration Deadline:
April 18th, 2017
Registration forms must be submitted by this date. No registrations will be accepted on
the day of the event. Please note that all registration forms or cheques that are filled out
incorrectly will not be processed and you will be unable to compete in the Senior Games.
Please fill out and sign the attached waiver to complete the registration process.
Payment is cheque only
Cheque payable to:
District #22 Hamilton/Wentworth 55+ Games
NSF cheques will be assessed a $40.00 processing fee.
Mail completed registration forms to:
District #22 Hamilton/Wentworth 55+ Games
c/o Ancaster Senior Achievement Centre (ASAC55+)
622 Alberton Road S., Alberton, ON LOR 1A0
905-546-2999
Drop off completed registration forms (with waiver) at the following locations:
Ancaster Senior Achievement Centre
622 Alberton Road S
Alberton, Ontario
Sackville Hill Senior Centre
780 Upper Wentworth Street
Hamilton, Ontario
Flamborough Senior Centre
163 Dundas Street East
Waterdown, Ontario
Special Requirements: Please list any special requirements you may need i.e.
wheelchairs, walkers, etc. and we will make every attempt to accommodate you.
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2017 OSGA 55+ South Central Regional Games: If you win at the District Games,
are you prepared to participate in the Games being held in Hamilton on Tuesday August
29th, 2017
YES or NO (please circle one)
PLEASE COMPLETE ATTACHED EVENT LIST
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District #22
Hamilton/Wentworth 55+ Games
2017 Registration Form
Events

st
1 Event
$10

2nd +
Events
$3+
Partners
Bid Euchre – Open Doubles
Billiards – Snooker – Open Singles
Bocce – Open Doubles
Bowling (Five Pin) - Open Team (5 Players) – 55+*
Carpet Bowling – Open Doubles
Contract Bridge – Open Doubles
Cribbage – Open Doubles
Cycling - Prediction – 5km – Men 55+
Cycling - Prediction – 5km – Women 55+
Cycling - 10km Time Trial – 10km – Men 55 - 64
Cycling - 10km Time Trial – 10km – Men 65+
Cycling - 10km Time Trial – 10km – Women 55 - 64
Cycling - 10km Time Trial – 10km – Women 65+
Darts – Open Doubles
Duplicate Bridge - Open Doubles
Euchre – Open Doubles
Golf - Callaway – Men 55 – 64*
Golf - Callaway – Men 65 – 74*
Golf - Callaway – Men 75+*
Golf – Callaway - Women 55 – 64*
Golf - Callaway – Women 65 – 74*
Golf - Callaway – Women 75+*
Lawn Bowling – Mixed Triples
Nordic Walk - Prediction – 1 km - Men
Nordic Walk – Prediction – 3 km – Men
Nordic Walk - Prediction – 1 km - Women
Nordic Walk - Prediction – 3 km – Women
Pickleball – Doubles – Men 55 – 64
Pickleball – Doubles – Men – 65+
Pickleball – Doubles – Women – 55 – 64
Pickleball – Doubles – Women 65+
Pickleball – Doubles – Mixed 55 – 64
Pickleball – Doubles – Mixed 65+
Run – Prediction – 5km – Men 55+
Run – Prediction – 5km – Women 55+
Shuffleboard – Open Doubles
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District #22
Hamilton/Wentworth 55+ Games
2017 Registration Form
Events

st
1 Event
$10

2nd +
Events
$3+
Partners
Swimming - Prediction - 200m – Men 55 – 64
Swimming - Prediction - 100m – Men 65+
Swimming - Prediction – 200m – Women 55 – 64
Swimming - Prediction – 100m – Women 65+
Swimming – Open Sprint – 50m – Men 55 – 64
Swimming – Open Sprint – 25m – Men 65 – 74
Swimming – Open Sprint – 25m – Men 75+
Swimming – Open Sprint – 50m – Women 55 – 64
Swimming – Open Sprint – 25m – Women 65 – 74
Swimming – Open Sprint – 25m – Women 75+
Swimming – Four Sprint Medley – 50m – Men 55 – 64
Swimming – Four Sprint Medley – 25m – Men 65 – 74
Swimming – Four Sprint Medley – 25m – Men 75+
Swimming – Four Sprint Medley – 50m – Women 55 – 64
Swimming – Four Sprint Medley – 25m – Women 65 – 74
Swimming – Four Sprint Medley – 25m – Women 75+
Tennis – Doubles – Men 55 – 64
Tennis – Doubles – Men 65 – 74
Tennis – Doubles – Men 75+
Tennis – Doubles – Women 55 – 64
Tennis – Doubles – Women 65 – 74
Tennis – Doubles – Women 75+
Tennis – Doubles – Mixed 55 – 64
Tennis – Doubles – Mixed 65 – 74
Tennis – Doubles – Mixed 75+
Walking – Prediction – 3km – Men 55+
Walking – Prediction – 1600m – Men 75+
Walking – Prediction – 3km – Women 55+
Walking – Prediction – 1600m – Women 75+
FIRST EVENT: $10 ALL OTHERS: $3 each
Additional Fees:
*Golf: $35 Green fee and cart
*Bowling: $8.50
Full Name:_________________________________
TOTAL FEES:_______________________
Signature: _________________________________
Date: _____________________________________
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