2024 Inland Empire Senior Games Registration
Athlete Registration fee is required to participate in all individual and doubles events, with the exception of Softball. Each participant must fill out a separate application
Athlete ’ s Name - Please Print Athlete ’ s Gender: Male
Female
PICKLEBALL
Skill Level: 2.0 - 2.5
3.0 - 3.5
4.0 - 4.5
SWIMMING
Doubles Partner ’ s Name:________________ Age _____ Partners Gender: Male Female Mixed Doubles Partner ’ s Name:________________ Age _____ Partners Gender: Male Female
Freestyle
50Yd (11)
100Yd (8)
200Yd (1)
Backstroke 50Yd (9)
100Yd (13) 200Yd (6)
Butterfly
CORNHOLE Doubles
50Yd (5)
100Yd (7)
200Yd(10)
Singles
Breaststroke 50Yd (3)
Partner ’ s Name:__________________ Age _____ Partners Gender: Male Female
100Yd (12)
200Yd(14)
Individual Medley 100IM (4)
SOFTBALL
200IM (2)
Co - Ed ($200 Per Team / No Registration Fee) Team Name:______________________________ Captain Name:____________________________ BOWLING Singles Doubles Partner ’ s Name:________________ Age _____ Partners Gender: Male Female Mixed Doubles Partner ’ s Name:________________ Age _____ Partners Gender: Male Female
BILLIARDS
Doubles
Singles
Partner ’ s Name:__________________ Age _____ Partners Gender: Male Female CORNHOLE
Doubles
Singles
Partner ’ s Name:__________________ Age _____ Partners Gender: Male Female
PAYMENT
WALK/RUN
Event(s) Fee _______ How many events are you registered for: _______
Walk
Run
5k
10k
5k
10k
Events # X $10: _______ Registration Fee: $15.00 Donations: _______
OFFICE USE ONLY
Receipt #:_____________
Date Received: _________
Staff Initial :_______
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