Name _________________________________ Age ______ Sport _____________________
Birthdate ____/_____/_____  Address ___________________________________________
City ________________  Zip ________  Telephone _______________ Email _____________

For Bowling: Age Division _________________ Final 06-07 Average: ___________________
    T-shirt size : ________________________________
     Doubles event: ____________Partner: ___________________ Partner's Avg: __________
For Track and Field: Age Division __________ Events (list up to four) ___________________
     ________________________________________________________________________
For Table Tennis (sanctioned events): USATT membership # _____________ Rating _______
    Singles events: ___________________________________________________________
    Doubles events: ______________________  Partner: ______________________________
 

For Badminton:

Men's Singles______     Women's Singles______
Men's Doubles ______    Partner_______________________________________

Women's Doubles_____   Partner______________________________________
Mixed Doubles _______  Partner______________________________________

Described your level of play and provide information for seeding purposes:
_______________________________________________________________
_______________________________________________________________

For Tennis: Age Division: ___________  Seeding Information: ________________________
     Doubles event: ______________________  Partner: _______________________________
For Racquetball: USAR Membership # ________________ Singles event: ________________
          Doubles event: _____________________ Partner: _____________________________

If your division is canceled due to lack of entries, do you want to be placed in another division?
___ Yes   ___ No           Alternate division(s) ________________________________________
(Note: in golf and track and field, divisions with only one entrant will still be run.  You will be
notified if you are the only entrant in a division to allow you the option of changing divisions)

Sport ___________________________________ Division ___________________________
Team Name: ________________________________________________________________
Team Captain/Contact _________________________________________________________
Address _________________________________________ City ______________________
Telephone _______________________________ Email ______________________________
If your team's division is canceled due to lack of entries, do you want to be placed in another division?
___ Yes   ___ No           Alternate division(s) _______________________________________

Team Roster (list names below - each entrant must sign and submit a release of liability (below)

1. _______________________________ phone: ______________________
2. _______________________________ phone: ______________________
3. _______________________________ phone: ______________________
4. _______________________________ phone: ______________________
5. _______________________________ phone: ______________________
6. _______________________________ phone: ______________________
7. _______________________________ phone: ______________________
8. _______________________________ phone: ______________________
9. _______________________________ phone: ______________________
10. ______________________________ phone: ______________________
11. ______________________________ phone: ______________________
12. ______________________________ phone: ______________________
13. ______________________________ phone: ______________________
14. ______________________________ phone: ______________________
15. ______________________________ phone: ______________________
16. ______________________________ phone: ______________________
17. ______________________________ phone: ______________________
18. ______________________________ phone: ______________________
19. ______________________________ phone: ______________________
20. ______________________________ phone: ______________________

In consideration of being allowed to participate in any way in the State Games of Indiana program, its related events and activities, I, __________________, the undersigned, acknowledge, appreciate and agree that:

1. The risk of injury from the activities involved in this program is significant, including the potential for permanent paralysis and death, and while particular skills, equipment, and personal discipline may reduce the risk, the risk of serious injury 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, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the Company immediately; and.

4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, hereby release, indemnify, and hold harmless the State Games of Indiana, their officers, officials, agents and/or employees,other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used for the activity ("Releasees"), with respect to any and all injury, disability, death, or loss or damage to person or property, whether arising from the negligence or the releaseew or otherwise, to the fullest extent permitted by law.

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.

___________________________________ Age: __________  Date signed: _________________
Participants' signature

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release as provided above of all the Releasees, and, for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child's involvement or participation in these programs as provided above, even if arising from the negligence of the releasees, to the fullest extent permitted by law.

______________________________ Emergency Phone: _________________ Date:______________
Parent/Guardian signature

Separate SIGNED AND DATED releases of liability must be submitted for each team member.
 

PLEASE NOTE:
Refer to your sport's web page for mailing address information.