2015 Senior Games Registration Form - Parks & Recreation

2015
Registration Packet and Games Information
APRIL 13th – MAY 8th
Registration Deadline: Friday, March 27th
Gold Sponsor
Silver Sponsor
Coordinating Agencies
Ellen Fitzgerald Senior Center
Council on Aging in Union County
Hosting Facilities
Belk-Tonawanda Park
Mecklenburg County Aquatics Center
Irish Creek Golf Course
Parks Williams Athletic Complex
Monroe High School
Ellen Fitzgerald Senior Center
Skyway Lanes
Lowe’s Motor Speedway
Dickerson Center
Important Information
Who:
Any Union County resident who resides in Union County at least 3 months out of the year and is
age 50 or better as of December 31, 2015. Proof of age and residency in Union County, North
Carolina may be required at registration. Participation in United Senior Games is necessary to
qualify for North Carolina State Finals in Raleigh, North Carolina. State Finals Entry Forms will
be given to USG 1st, 2nd, and 3rd place winners in qualifying events along with their medals.
Golfers must meet a minimum performance score (MPS) and finish 1, 2, or 3 to qualify.
It is your responsibility to check with your local Games Event Director to determine if
you qualify for State Finals and to get a State Finals Entry Form. The State Finals
registration deadline of August 1st is strictly enforced. For more information call the Ellen
Fitzgerald Senior Center 704-282-4657.
When:
The United Senior Games will be held between the dates of April 13 and May 8. For more
detailed information on events, check the event calendar for specific days and times.
Where:
Events will be held in various locations throughout Union County. Locations are listed on the
Events Registration Form and on the Events Calendar.
Awards:
Gold, Silver, and Bronze medals will be presented to all 1st, 2nd, and 3rd place men and women
competitors in each category in athletic competitions. SilverArts includes a “Peoples Choice
Award”. SilverArts participants will receive Ribbons for 1st, 2nd, and 3rd place. Awards are not
mailed to winner. Whenever possible awards are presented at the conclusion of each event.
Age Group:
Your competing age is determined by your age as of December 31, 2015. Men and women
compete in separate categories in the following five-year age groups: 50-54, 55-59, 60-64,
65-69, 70-74, 75-79, 80-84, 85-89, etc.
Equipment:
Participants are required to provide their own equipment for cycling, golf, and SilverArts props.
Participants may use their own equipment in all events if it meets the official standards. Check
with your Event Manager prior to the scheduled date of event about the use of personal
equipment.
Rules:
Official North Carolina Senior Games Rule Books are available. If you have any questions
about your event, please check the rules prior to participation.
Sanctioning:
This program is sanctioned by North Carolina Senior Games Inc. NCSG is sponsored statewide
by the N.C. Division of Aging and Adult Services.
Health:
To promote total health and physical fitness, events of longer duration and lower intensity are
strongly recommended. High-intensity types of activities are offered primarily for the
conditioned-trained athlete. It is recommended that you consult with your physician prior to
beginning training and actual competition.
How to Register:
1. Complete the registration packet. Please provide all requested Information.
2. Choose the events and activities in which you want to participate.
3. If you are a SilverArtist you must submit the SilverArts Registration Form with your packet.
4. Pay the registration fee (required) of $10.00 by Friday, March 27th .
(Registration after March 27th is $12.00). Remember to include additional fees if required.
Make Checks Payable to Monroe Parks and Recreation.
5. Mail your completed packet and required fees to:
Ellen Fitzgerald Senior Center
Attn: Senior Games
327 South Hayne Street
Monroe, N.C. 28112
UNITED SENIOR GAMES EVENTS REGISTRATION
Events are listed in order by the scheduled date. For more details about an event refer to the USG calendar. Please
select the events you will participate in by marking the appropriate box with an “X”. Note: Some events require a
fee in addition to the required Registration Fee.
Monday, April 13
Dickerson Center
□ Table Tennis* (Tournament Format)
Monday, April 27
Irish Creek Golf Course (Additional Fee Required)
□ Golf & Lunch ($48.00)
Tuesday, April 14
Lowe’s Motor Speedway
□ Cycling
Tuesday, April 14
Ellen Fitzgerald Senior Center
□ Bridge Tournament**
Wednesday, April 15 (Rain Date: Thurs. April 16)
Monroe High School
Track and Field
□ 100 M Dash
□ 200 M Dash
□ 400 M Dash
□ 800 M Dash
□ Shot Put
□ Discus
□ Running Long Jump
□ Standing Long Jump
Thursday, April 16
Ellen Fitzgerald Senior Center
□ Canasta Tournament**
Friday, April 17 (Rain Date: Thursday, April 24)
Belk-Tonawanda Park
□ Bocce* (Tournament Format)
Monday, April 20
Ellen Fitzgerald Senior Center
SilverArts Literary entries due
Tuesday, April 21 (Rain Date: Wednesday, April 22)
Dickerson Center
□ Opening Ceremony / Fun Walk*
□ Open Events*
Football Throw
Softball Throw
Basketball Shooting Spin Casting
* Lunch provided by Humana
Wednesday, April 22
Ellen Fitzgerald Senior Center
□ Pinochle Tournament**
Thursday, April 23
Dickerson Center
To Qualify for State Finals, golfers need to meet a minimum
performance score and finish in the top 3 in their age group.
Tuesday, April 28 – Wednesday, April 29
Skyway Lanes (Additional Fee Required)
Bowling
Choose only one doubles event
4/28 □ Doubles ($6.00) Tues.
□ Mixed Doubles ($6.00) Tues.
Doubles Partner Name _________________
4/29
□ Singles ($6.00) Wed.
Thursday, April 30 (WOMEN) (Rain Date: Wed. May 6)
Parks Williams Athletic Complex
□ Horseshoes* (Tournament Format)
□ Shuffleboard* (Tournament Format)
Monday, May 4 (Rain Date: Tues. May 5)
Dickerson Center
Pickleball* (Tournament Format)
□ Singles
□ Doubles
□ Mixed Doubles
Doubles Partner Name _________________
Tuesday, May 5
Ellen Fitzgerald Senior Center
□ Spades Tournament**
Wednesday, May 6 (MEN) (Rain Date: Thurs. May 7)
Parks Williams Athletic Complex
□ Horseshoes* (Tournament Format)
□ Shuffleboard* (Tournament Format)
Friday, May 8
Monroe Country Club
□ Closing Ceremony (Ticket Required)
Includes Covered Dish Dinner, Performing Arts,
and Awards Ceremony. ($5 guest ticket available)
□ Cornhole* (Tournament Format)
Date and Time (TBA)
Thursday, April 23 (1pm-5pm)/Friday April 24 (8am-12)
Ellen Fitzgerald Center Senior
□ Swimming
□ SilverArts drop-off
Sunday, April 26th
Ellen Fitzgerald Senior Center
□ SilverArts Showcase/
Open House
REGISTRATION DEADLINE:
Friday, March 27, 2015
* Tournament with assigned times
** Not Sanctioned by NCSG
UNITED SENIOR GAMES SilverArts REGISTRATION
All entries must meet NCSG SilverArts Guidelines and Specific Requirement to be eligible for local and
state competition. SEE NCSG SilverArts REQUIREMENTS INCLUDED IN THIS PACKET.
All entries must include your name and category and submitted by specific deadline.
Please select the appropriate category for your entry by marking the appropriate box with an “X”. All blanks must be
completed for each entry. Participants may enter a total three (3) pieces, with no more than one entry per subcategory line.
Visual Arts
Sub-Category
Title
□ Alcohol Ink*_______________________________
□ Acrylic___________________________________
□ Charcoal _________________________________
□ Collage*__________________________________
□ Drawing__________________________________
□ Mixed Media_______________________________
□ Oil ______________________________________
□ Pastels __________________________________
□ Photography ______________________________
□ Sculpture _________________________________
□ Watercolor________________________________
Heritage Arts
Sub-Category
Title, Design/Pattern/Medium
□ Basket Weaving ____________________________
□ Ceramics*__________________________________
□ China Painting______________________________
□ Crocheting_________________________________
□ Rugs (hooked, braided, woven) _______________
□ Jewelry____________________________________
□ Knitting____________________________________
□ Needlework_________________________________
□ Pottery (thrown & hand built)___________________
□ Quilting (hand and machine) ___________________
□ Sewing*___________________________________
□ Stained Glass_______________________________
□ Tatting & Needlelace _________________________
□ Tole Painting________________________________
□ Wearable Art*_______________________________
□ Weaving ___________________________________
□ Wood Carving_______________________________
□ Woodturning________________________________
□ Wood Working ______________________________
*Not sanctioned by NCSG
Performing Arts
An artist may only participate in one Sub-Category
Sub-Category
Title/# in group/group leader
□ Vocal _____________________________________
□ Dance____________________________________
□ Instrumental________________________________
□ Comedy/Drama_____________________________
□ Line Dancing_______________________________
All participants, including accompanists, must be officially
registered with United Senior Games.
Category Checklist available at registration desk
Performing Arts
Performances will be featured at the Closing
Ceremony at the Monroe Country Club
Ballroom on Friday evening, May 8.
SilverArts Open House Showcase
Visual Arts, Heritage Arts, and Literary Arts
entries will be on display at the Ellen Fitzgerald
Senior Center on Sunday, April 26,
2:00-4:00PM.
Literary Arts (Must be submitted no later than April 1.)
Sub-Category
Title
□ Poem_____________________________________
□ Short Story (fiction) __________________________
□ Essays ___________________________________
□ Life Experiences (autobiographical)________________________
No late work will be accepted.
Please Read Carefully Before Signing
I understand that my entry must meet all North Carolina Senior Games Requirements that have been provided in
the registration package to be eligible for competition. I also understand that my entry must be submitted with my
name and category, and title prior to the listed deadlines to be considered during the judging process. My Visual,
Heritage, and/or Literary entries were completed after April 2013 .
_________________________________________________________
______________________________
Participant Signature
Date
READ THIS INFORMATION CAREFULLY BEFORE SIGNING
LIABILITY RELEASE FORM
MONROE PARKS AND RECREATION
UNITED SENIOR GAMES
All participants in the United Senior Games understand that these activities may subject participants to
rigorous physical exertion. All participants should also understand that these activities might, from time to
time, involve a degree of risk of accident or physical injury while participating in portions of the group’s
activities. I the undersigned further understand that the City of Monroe does not accept or assume any
responsibility or liability for accident, personal injury, or property damage resulting from participation in the
United Senior Games.
All participants should understand that the City of Monroe does not provide accident insurance for
participants in the United Senior Games, on this prior knowledge; the undersigned understands that it is
the responsibility of the participant to possess adequate personal insurance.
I have the right to inspect the facilities or equipment and will notify the instructor or supervisor of the Parks
and Recreation Department of any objection to the supervision, instruction, facilities, or equipment used in
the connection therewith.
Based on this prior knowledge, the undersigned hereby states that, to the best of his/her knowledge
and belief he or she is in sufficient physical condition to accept a rigorous level of physical activity. On this
basis, the undersigned hereby releases and agrees to save harmless the City of Monroe, Monroe Parks
and Recreation Department, any members of its staff and volunteers from any liability occasioned by the
failure of the undersigned to possess physical conditioning efficient to withstand rigorous physical activity.
The undersigned further releases and agrees to save harmless the City of Monroe, Monroe Parks and
Recreation Department, any members of its staff and volunteers from any liability or responsibility for
accidents, person injury, or property damage as a result of participation in, or the use of equipment
belonging to City of Monroe and Monroe Parks and Recreation Department.
I agree to give United Senior Games the right to use any photographs or video taken of me, or quote
made by me in order to promote the United Senior Games program.
“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.”
________________________________________________
Participant Signature
________________________
Date
___________________________________________
Emergency Contact
______________________
Relationship
____________________________
Phone
THIS FORM MUST BE SIGNED AND INCLUDED IN YOUR REGISTRATION PACKET.
United Senior Games Official Registration Form
Registration Deadline: 12:00 Noon - Friday, March 27, 2015
Late Registration Subject to Additional Fee
Please Print Clearly
Name
_________________________________________________________________________________________________________________________
Last
First
Middle Initial
Address
NC______________________________
__________________________________________________________________________________
(Residence Address)
City
State
Zip Code
Home Telephone______________________________ Email address________________________________________
Age (As of December 31, 2015) _____ Date of Birth_______________
Gender:
□ Male
□ Female
m/d/y
_________________________________________________________________________________________________________________________
Please provide the following information to help NCSG. It will be kept confidential. Thank you!
Ethnicity: □ Black or African American □ Asian □ Hispanic □ American Indian or Alaska Native □ White □ Native
Hawaiian or other Pacific Islander □ Hispanic □ Unknown/Refused
Income: Annual household income is less than $ 11,670.00 (1 person in household) □ yes □ no
Annual household income is less than $ 15,730.00 (2 people in household)
No Response □
□ yes □ no
_________________________________________________________________________________________________________________________
Registration Fees
All participants are required to pay a registration fee ($10.00). Some events require additional fees.
Registration Fee will only be refunded if the participant cancels registration by March 27, 2015. All fees must be paid in
full prior to your participation.
Registration Fee (Required)
$10.00------------$___________
Includes: Closing Ceremony Ticket and T-shirt (circle size: S M L XL XXL)
Guest Ticket for Closing Ceremony
$5.00--------------$___________
Additional Activities Fees:
Bowling – Singles--------------------------------------------------------$6.00------------ $___________
Bowling – Doubles-------------------------------------------------------$6.00-each---- $____________
Bowling - Mixed Doubles------------------------------------------ ----$6.00-each---- $____________
Golf & Lunch--------------------------------------------------------------$48.00--------- $____________
Late Registration Fee
$2.00-----------$____________
TOTAL (Enclosed Check or Money Order Only)----------------------------$_____________
Please make checks payable to Monroe Parks and Recreation
Mail completed Registration Packet with Required Fees to:
Ellen Fitzgerald Senior Center
Attn: Senior Games
327 South Hayne Street
Monroe, N. C. 28112
North Carolina Senior Games SilverArts Requirements
ALL Entries must meet the specific category requirement set by NCSG to be eligible for competition through United Senior Games.
Any entry that does not meet these requirements will not be judged for competition. All entries will be displayed if submitted.
Heritage Arts

Entries must be the work of the individual and not a
group.

Heritage Art entries must be an original work of the
artist and must have been completed within 2
years of the Local Games’ qualifying date.
Patterns may be used, but no stamped pieces will
be accepted.

Pottery must be hand built or thrown.

Latch hook rugs and pieces for ceramic molds will
not be accepted

All framed work must be securely wired, ready to be
hung (no serrated hooks or string). Twodimensional work not properly framed and wired will
not be displayed

Framed works can be no larger than 36” x 42”,
including matting and 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.

Artist’s name and title entry must appear on, or be
attached to, entry for identification.

Winning artist must send a photo of entry with State
Finals Entry Form and SilverArts Information Form.
Photos cannot be returned.

Artists, or their representatives, are responsible to
deliver and pick-up their entry at/during the
designated times.

The Heritage Arts piece entered at State Finals
must be the same piece that won at the Local
Games.

An artist may only submit one (1) entry per subcategory at State Finals.
Literary Arts : Deadline to submit entry - April 1.

All entries must be typed, double-spaced, on
8 ½ x 11 paper and have a minimum of 1”
margins. A minimum font size is 10-point type.

The entry must have been completed within 2
years of the Local Games’ qualifying date.

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 work, sub-category, and name of artist.

Artist’s name should not appear on the content
pages.

A display-quality copy of the winning Literary Arts
entries and three (3) additional photocopies should
be submitted to NCSG by the artist with their official
State Finals Entry Form and SilverArts Information
Form. No framed or matted entries will be
accepted.

The original and all copies will be retained by
NCSG, Inc.

The literary arts piece entered at State Finals must
be the same piece that won at the Local Games.
Visual Arts

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’ x 5’ height

Artist, 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,
and must have been completed within 2 years of
the Local Games’ qualifying date

Artist’s name and title of entry must appear on, or
be attached to, entry for identification.

Artist must send a photograph of entry with State
Finals Entry Form and SilverArts Information Form.
Photos cannot be returned.

The visual arts piece entered at State Finals must
be the same piece that won at the Local Games.

An artist may only submit one (1) entry per subcategory at State Finals.
Performing Arts*
 An artist may only participate in one sub-category.




Performing entries are limited to three (3) minutes
of onstage time. Exceeding the time limit will result
in automatic disqualification. Timing begins with
the first note of music or the first movement visible
to the audience and ends with the exit of the last
performer.
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. 31, 2015, will
be permitted on stage and an accompanist must
be a registered participant. The group leader must
be a registered participant.
If recorded music is used, the artist/group leader
must use a high-quality CD for their performance.
No recorded instruction is permitted. The
music/song should be the only music on the CD.
Voice presentations must be a live performance by
the artist. Background music can be recorded. Lipsynch is not permitted as a performing art.
*Requirements have been abbreviated, request the
entire State Final requirements from the United
Senior Games coordinating agency, Ellen
Fitzgerald Senior Center.
2015 United Senior Games Calendar
Date
Time
Event
Location__________________
Friday, March 13
10:00AM
Bowling Registration & Morning Snacks
Skyway Lanes
Friday, March 27
12:00 noon
Registration Deadline
Ellen Fitzgerald Senior Center
Monday, April 13
10:00AM
Table Tennis
Dickerson Gym
Tuesday, April 14
10:00AM
Cycling
Lowes Motor Speedway
Tuesday, April 14
12:30PM
Bridge Tournament**
Ellen Fitzgerald Senior Center
Wednesday, April 15
(Rain Date: April 16)
10:00AM
Track & Field Events
Monroe High School
Thursday, April 16
12:30AM
Canasta Tournament**
Ellen Fitzgerald Senior Center
Friday, April 17
(Rain Date: April 24)
1:30PM
Monday, April 20
8AM-5PM
SilverArts Literary entries due
Ellen Fitzgerald Senior Center
Tuesday, April 21
(Rain Date: April 22)
9:30AM
10:00AM
Opening Ceremony/ Fun Walk
Open Events
Dickerson Center
Dickerson Center
Wednesday, April 22
12:30AM
Pinochle Tournament**
Ellen Fitzgerald Senior Center
Dickerson Gym
Bocce
(Tournament w/ Assigned Start Times)
Belk-Tonawanda Park
Thursday, April 23
10:00AM
Cornhole
(Tournament w/ Assigned Start Times)
Thursday, April 23
Friday, April 24
1PM-5PM
8AM- 12PM
SilverArts Heritage & Visual Arts entries drop-off Ellen Fitzgerald Senior Center
SilverArts Heritage & Visual Arts entries drop-off Ellen Fitzgerald Senior Center
Sunday, April 26
2:00-4:00PM
SilverArts Showcase/Open House
Ellen Fitzgerald Senior Center
Monday, April 27
9:30AM
Golf
Irish Creek
Tuesday, April 28
10:00AM
Bowling Doubles/Mixed Doubles
Skyway Lanes
Wednesday, April 29
10:00AM
Bowling Singles
Skyway Lanes
Thursday, April 30
10:00AM
Horseshoes/Shuffleboard (WOMEN)
(Tournaments w/ Assigned Start Times)
Parks Williams Field
Monday, May 4
(Rain Date: May 5)
10:00AM
Pickleball
Dickerson Center
Tuesday, May 5
9:00AM
Spades Tournament**
Ellen Fitzgerald Senior Center
Wednesday, May 6
(Rain Date: May 7)
10:00AM
Horseshoes/Shuffleboard (MEN)
(Tournaments w/ Assigned Start Times)
Parks Williams Athletic Complex
Friday, May 8
5:30PM
Closing Ceremony (Ticket required)
Covered Dish /Awards/ Performing Arts
Monroe Country Club Ballroom
TBA
TBA
Swimming
MAFC
** Event not sanctioned by NCSG
Dates and Times are subject to change due to inclement weather.

For more detailed information about dates, times, and events contact: Ellen Fitzgerald Senior Center 704-282-4657