registration                            

    A copy of Proof of Age must be Included (Birth Certificate/Drivers License/etc.)

        Date of Birth:                                       

        Your Age on December 31, 2003:       

        Age Groupings are in 5 year increments:

        50 to 54     55 to 59     60 to 64     65 to 69      70 to 74 

         75 to 79     80 to 84    85 to 89     90 & over

        Sex:  Male Female   Social Security Number: 

        PARTICIPANT INFORMATION:

        Have you ever participated in any Senior Games?            Yes   No

        MEDICAL HISTORY:

1. List any medications you are currently taking:
   

2. Are you currently being treated for any medical condition?      Yes    No
   List: 
   

3. Are you allergic to any medications?                                        Yes    No
   List: 
   

        
TEAM EVENTS 
The age group is determined by the youngest player as of December 31, 2003.  Entry in these events is by team only.  However each individual must complete a games entry and pay the appropriate fees.  Team captains must supply the team roster for bowling, basketball, softball, and volleyball (form provided on the last page).  Include name, age, and date of birth for each member of the team.  Team manager must submit all individual registration forms, monies, and ids for their respective teams.  

 ATHLETIC EVENTS   

 COMPETITIVE EVENTS

        I am a Creative Writing entrant who:  will   will not                attend the games in person.

Enter your comments below:

      Liability Waiver

        I, the undersigned participant, upon submission of this,  hereby agree to indemnify, save, and hold harmless the CCSG organization, the City of Corpus Christi, and any of their agents and/or representatives for any loss due to my health, safety, or injury resulting from my participation in the Corpus Christi Senior Games.

        I, have prepared myself for the events I have entered by practicing prior to these games.  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.  CCSG has my permission to have a physician attend me if deemed necessary during my participation in the Corpus Christi Senior Games.

        I, additional agree and grant the Corpus Christi Senior Games and any of their agents and representatives the right to use any pictures taken of me, including my name and city that I am from during the Games to be held in February 2003 without any remuneration to me.

Signature: 

Date:          

Credit Cards Accepted:    
(check one)      Visa      MasterCard

Card Number: Exp. Date:

Please mail application to: (no mailbox at this time)

Corpus Christi Senior Games
Copyright © 1999 [Corpus Christi Senior Games]. All rights reserved.
Revised: November 15, 1999 .

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