BLUECROSS BLUESHIELD - ACADIANA DISTRICT SENIOR GAMES LAFAYETTE, LA JANUARY 29 - FEBRUARY 16, 2022 JANUARY 25, 2022
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2022
ACADIANA DISTRICT
SENIOR GAMES
LAFAYETTE, LA
JANUARY 29 - FEBRUARY 16, 2022
REGISTRATION DEADLINE
JANUARY 25, 2022
SPONSORED BY:
BlueCross
BlueShield
1GENERAL INFORMATION FOR
ACADIANA DISTRICT SENIOR GAMES
COORDINATOR: GREG GARBARINO, 337-262-5990
I INFORMATION FOR ALL ENTRANTS
ELIGIBILITY: The Acadiana District Senior Games are open to anyone who is at least 50 years of age by
December 31, 2022. Athletes, who are first time participants, are required to submit
N proof of age with the entry/registration form. The Acadiana games are an OPEN event.
Out‑of‑state residents are eligible and encouraged to participate. All competitors must
have their entry forms to the Lafayette Council on Aging office by January 25, 2022.
All participants must be registered to participate. Out of District/State must finish in
F the top 3 to receive an award. Age division for doubles will be determined by the age of
the youngest partner. The 2022 Acadiana District Games is a qualifying site for State
Senior Games.
O DATES: JANUARY 29 - FEBRUARY 16, 2022
MAIL IN DEADLINE: JANUARY 25, 2022
FEES: Badminton $10.00 Golf $25.00 Throws $10.00
R
Basketball $10.00 Miniature Golf $12.50 Washer Pitch $10.00
Dance Team $10.00 Horseshoes $10.00 Track and Field $10.00
Bean Bag Baseball $10.00 Marksmanship $10.00
Bench Press $10.00 Pickleball $20.00 Additional Fee for Sports
M Billiards $10.00
Bowling $12.50
Shuffleboard $10.00
Swimming $10.00
over three: $3.00
Excluding Pickleball, Golf,
Card Games $10.00 Table Tennis $10.00 Miniature Golf, and Bowling
A
Free Sr. Olympic T-shirt with registration of 3 sports.
DOUBLES - MIXED DOUBLES: Partners need to submit their entry forms in the same envelope.
WEATHER POLICY: Sports using outdoor sites are weather dependent. Competitions will be
T conducted unless an Acadiana Senior Games official determines weather conditions to
be potentially dangerous or life threatening, or if the playing fields would incur significant
damage. IMPORTANT: In checking your sports, be sure that you avoid conflicts of times
in each sport checked. All times stated are starting times. SPORTS ARE IN BOLD PRINT.
I GUESTS: Family and friends are welcome to attend all sporting events free of charge.
DISTRICT GAMES are designed to make available additional competition in athletic events
O already being held at the state level. Each district will not offer all 72 sport categories
available at the state games. Athletes may also qualify by meeting minimum qualifying
standards for each starred event.
N NOTE: NO REFUNDS AFTER JANUARY 25, 2022 DEADLINE
For information about the State Championship Games
visit www.LSOGI.net
ACADIANA DISTRICT SENIOR GAMES
160 Industrial Parkway, Lafayette, LA 70508
Phone: (337) 262-5990 • srolympicslcoa@gmail.com
2ACADIANA DISTRICT SENIOR GAMES ENTRY FORM
— RETURN THIS FORM —
Return 1) entry form, 2) waiver, 3) entry fees and 4) birthdate verification to:
Acadiana District Senior Games, ATTN: Greg Garbarino
160 Industrial Pkwy., Lafayette, LA 70508
Make checks payable to Lafayette Council on Aging, Inc.
FILL IN LEGIBLY WITH BLACK BALLPOINT PEN
E
LAST NAME FIRST NAME MI SEX
BIRTHDATE: MONTH/DAY/YEAR AGE AS OF 12/31/2022
ADDRESS N
CITY STATE ZIP PLUS FOUR
T
R
PARISH TELEPHONE: HOME
TELEPHONE: OTHER E-MAIL ADDRESS
Y
ENTRY OF THREE SPORTS INCLUDES T-SHIRT SHIRT SIZE: (Circle One) Small Medium Large X Large XXL XXXL
CHECK EACH SPORT AND EVENT IN WHICH YOU WISH TO PARTICIPATE
QUALIFYING EVENTS for the 2022 STATE GAMES are marked with an asterisk (*).
IMPORTANT: AVOID CONFLICTS BY CHECKING GAMES SCHEDULE FOR START TIMES!
F
BILLIARDS
BENCH PRESS/DEAD LIFT
MINIATURE GOLF
SKEEBALL
*GOLF, medal
MARKSMANSHIP
TRACK & FIELD
50 M Dash
100 M Dash
O
Pistol .22 200 M Run
CARD GAMES
Bourré
Texas Hold’em
PICKLE-BALL
Doubles
partner:___________
Rifle .22
*BOWLING singles
400 M Run
800 M Run
1500 M Run
R
Mixed Doubles 5K Run
HORSESHOES
*Choose only 1 of the
partner:___________
SWIMMING
FUN DAY
WASHER PITCH
800 M Recreational
Walk
M
BEAN BAG BASEBALL 1500 M Race Walk
horseshoe events
Recreational
50 M Free THROWS *Discus
*Advanced
100 M Free Football Accuracy High Jump
*SHUFFLEBOARD 50 M Back Frisbee Accuracy *Javelin
*Choose only 1 of the 100 M Back Softball Accuracy Long Jump
shuffleboard events 50 M Breast _ Softball Distance Triple Jump
*Advanced 100 M Breast *Shot Put
DANCE TEAMS
Recreational 100 M Medley _ *Hammer Throw TBD
— To enter the Hammer
Throw, you MUST enter
one of the other weight
throws (discus, shot or
javelin) Free Event
3ACADIANA DISTRICT SENIOR GAMES
MEDICAL INFORMATION
Louisiana Senior Olympic Games STRONGLY URGES that participants CONSULT THEIR PHYSICIANS in
I regard to practice, preparation, and competition in the Senior Olympic Games Program.
N
ACADIAN AMBULANCE MEMBER? YES ______ NO ______ MEMBERSHIP #____________________________________
EMERGENCY CONTACT ‑ FAMILY_________________________________________________ Phone_________________________
F PARTICIPANT WAIVER AND MODEL RELEASE - SIGN BELOW
In consideration of being allowed to participate in any way in the Louisiana Senior Olympic Games program, related
O
events and activities, the undersigned acknowledges, appreciates, and agrees that:
1. The risk of injury from the activities involved in these programs 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/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE
the Louisiana Senior Olympic Games Inc., its officers, officials, agents and/or employees, other participants,
sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessors of the premises used to conduct
the event (“Releasees”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to
W
person or property incident to my involvement or participation in these programs, 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/our heirs, assigns, personal representatives and next of kin, HEREBY INDEMNIFY
A
AND HOLD HARMLESS all the above Releasees from any and all liabilities incident to my involvement or
participation in these programs, EVEN IF ARISING FROM THEIR NEGLIGENCE, to the fullest extent permitted by
law.
I I, the undersigned participant, grant to the Louisiana Senior Olympic Games, Inc., the right to use any pictures taken
of me during the Louisiana Senior Olympic Games without my remuneration and in any medium the photographer/
staff sees fit for art, advertisement, exhibition, editorial, or any purpose whatsoever.
V 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
E
VOLUNTARILY WITHOUT ANY INDUCEMENT.
SIGNATURE__________________________________________ PRINTED________________________________ DATE__________________
R EMERGENCY CONTACT: NAME________________________________________________________ PHONE________________________
PACKET PICK-UP FOR 2022
Each Acadiana Registered Participant will pick up their Packet
at the site of their FIRST EVENT (SPORT).
4ACADIANA DISTRICT SENIOR GAMES
INFORMATION FOR ALL ENTRANTS
INSTRUCTIONS FOR ALL PARTICIPANTS:
1. Print or type all information requested on an entry form.
2.
3.
Waiver must be signed and dated at the bottom of entry form.
Include payment of all fees, additional guest for meals, tee shirts, Golf, Bowling, and Miniature Golf.
I
4. Include proof of age if you are a first time participant.
5. Shirt Size.
AGE CATEGORIES (determined by age as of December 31, 2022):
N
50-54 55-59 60-64 65-69 70-74
75-79 80-84 85-89 90+
F
(Ages 40-49 eligible to participate in Track & Field, Golf, and Swimming)
ENTRY FEES O
ENTRY FEES must be sent with this form ‑ checks made payable to: Lafayette Council on Aging.
• ENTRY FEE paid by JANUARY 25
Badminton $10.00 $_________ .00 Horseshoes $10.00 $_________ .00
&
Basketball $10.00 $_________ .00 Marksmanship $10.00 $_________ .00
Dance Team $10.00 $_________ .00 Pickleball $20.00 $_________ .00
Bean Bag Baseball $10.00 $_________ .00 Shuffleboard $10.00 $_________ .00
Bench Press $10.00 $_________ .00 Swimming $10.00
Table Tennis $10.00
$_________ .00
$_________ .00
F
Billiards $10.00 $_________ .00
E
Bowling $12.50 $_________ .00 Throws $10.00 $_________ .00
Card Games $10.00 $_________ .00 Washer Pitch $10.00 $_________ .00
Golf $25.00 $_________ .00 Track and Field $10.00 $_________ .00
Miniature Golf $12.50 $_________ .00 E
Additional Fee for Sports over three: ________ x $3.00 Excluding Pickleball, Golf, Miniature
Golf, and Bowling
S
$_________ .00
TOTAL AMOUNT ENCLOSED $_______ .00
Free Sr. Olympic T-shirt included with entry of three sports
I have checked the sport/event entries on this form and verify that they are correct. I have also signed
the liability waiver. I understand there are NO SUBSTITUTIONS or REFUNDS. All fees are enclosed.
Signature is required ____________________________________________________________ Date:______________
THIS FORM MUST BE SIGNED AND RETURNED WITH PARTICIPANT APPLICATION FORM.
5ACADIANA DISTRICT SENIOR GAMES
2022 TEAM ROSTER
Only one entry form per team should be completed and submitted with the entry form by the
team coach, captain, or other designated individual. All communication will be directed to the
captain. It will be the captain’s responsibility to turn in the roster and contact players regarding
T changes.
You Must Include Individual Team Members’ Entry Forms and I.D. Attached to This Entry Form.
SPORT: DANCE TEAM (mixed - max. roster 15) - All Ages
E BEAN BAG BASEBALL 50+
Team Name:______________________________________________________________________________________________________
A Team Captain:____________________________________________________________________________________________________
TEAM MEMBERS
M 1.______________________________________________________
2.______________________________________________________
10._____________________________________________________
11._____________________________________________________
3.______________________________________________________ 12._____________________________________________________
4.______________________________________________________ 13._____________________________________________________
5.______________________________________________________ 14._____________________________________________________
E
6.______________________________________________________ 15._____________________________________________________
7.______________________________________________________ DANCE TEAM
8.______________________________________________________
N 9.______________________________________________________
BEAN BAG BASEBALL
T TRACK & FIELD SCHEDULE
SATURDAY, FEBRUARY 12, 2022
R Note: Events will commence on times below and not earlier to allow athletes time to RECOVER.
TRACK FIELD
Y 10:15 AM – 50m Meter Dash
10:45 AM – 1500 Meter Race Walk
10:00 AM – LONG JUMP
10:30 AM – SHOT PUT
12:00 PM – 400 Meter Run 11:30 AM – DISCUS
12:30 PM – 1500 Meter Run 11:45 AM – TRIPLE JUMP
1:00 PM – 100 Meter Dash 12:30 AM – HAMMER THROW
1:30 PM – 800 Meter Walk 12:45 AM – HIGH JUMP
2:00 PM – 800 Meter Run 1:30 AM – JAVELIN
2:30 PM – 200 Meter Dash 1:45 AM – POLE VAULT
6ACADIANA DISTRICT SENIOR GAMES
PACKET PICK-UP: Each Acadiana Registered Participant will pick up their Packet at the site of their first event (sport).
—— KEEP THIS SCHEDULE ——
IMPORTANT: AVOID CONFLICTS BY CHECKING START TIMES!
*Starred Events are qualifying events for the 2022 State Championship Games.
EVENT CHECK IN / START TIME SITE
TBD
S
SWIMMING 7:30 AM 7:45 AM TBD
WEDNESDAY, JANUARY 26
MARKSMANSHIP 8:00 AM 8:15 AM 351 Michael Ann Drive
Sponsored by Parish Sheriff Lafayette, LA 70501
C
Training Academy Lunch will be served by Sheriff’s Office
THURSDAY, JANUARY 27
*BOWLING SINGLES 4:00 PM 4:15 PM ROCK N BOWL
905 Jefferson St., Lafayette, LA
H
SATURDAY, JANUARY 29
PICKLEBALL 9:45 AM 10:00 AM BOURGEOIS HALL
Sponsored by ULL & BLUECROSS/BLUESHIELD 225 Cajundome Blvd., Lafayette, LA
WEDNESDAY, FEBRUARY 2
E
BOUREÉ 8:30 AM 8:45 AM GIRARD REC CENTER
TEXAS HOLD ’EM 1:00 PM 1:15 PM 500 Girard Park Dr., Lafayette, LA
SATURDAY, FEBRUARY 5
BENCH PRESS / DEAD LIFT 2:00 PM 2:15 PM RED’S HEALTH CLUB
Sponsored by RED’S HEALTH CLUB
TUESDAY, FEBRUARY 8
301 Doucet Rd, Lafayette, LA
D
*HORSESHOES 8:30 AM 8:45 AM DUPUIS CENTER
1212 E. Pont Des Mouton, Lafayette, LA
BILLIARDS - 8 BALL
WEDNESDAY, FEBRUARY 9
9:00 AM 9:15 AM STICKS BILLIARD PARLOR (337-989-1727)
3220 Johnston St., Lafayette, LA
U
THURSDAY, FEBRUARY 10
*MINIATURE GOLF
*SKEE-BALL
10:00 AM 10:15 AM KART RANCH
10:30 AM 10:45 AM 508 Youngsville Hwy., Lafayette, LA L
SATURDAY, FEBRUARY 12
E
TRACK & FIELD 10:00 AM 10:15 AM TEURLINGS HIGH SCHOOL
Sponsored by RIGHT AT HOME 139 Teurlings Dr., Lafayette, LA
TUESDAY, FEBRUARY 15
*GOLF 8:00 AM 8:15 AM MUNICIPAL GOLF COURSE
1121 Mudd Ave., Lafayette, LA
WEDNESDAY, FEBRUARY 16
FUNDAY 8:00 AM GIRARD REC CENTER
WASHER PITCH 9:00 AM 500 Girard Park Dr.
Lafayette, LA
BEAN BAG BASEBALL TBD
THROWS 9:00 AM
(Football, Frisbee, Softball)
DANCE TEAMS 10:00 AM
*SHUFFLEBOARD 12:30 PM 12:45 PM
CELEBRATION OF ATHLETE 2:00 PM
Sponsored by RIGHT AT HOME
7ACADIANA DISTRICT SENIOR GAMES Non-Profit Org.
Lafayette Council on Aging U. S. Postage
160 Industrial Parkway PAID
Lafayette, LA 70508 Lafayette, LA
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