Games for Life Entry Form - CASACA



58801009461500City: FORMCHECKBOX Austin FORMCHECKBOX San Antonio FORMCHECKBOX Dallas/Ft. Worth FORMCHECKBOX HoustonFacility Name: FORMTEXT ?????Contact Person: FORMTEXT ?????Cell Phone Number: FORMTEXT ?????Email: FORMTEXT ????? (This is the email you can best be reached)Directions: Please fill out on computer and print. Don’t forget to include the following in your packet: Physician’s orders, liability waivers for each resident, banner narrative, and arts & crafts sheets. Please register every resident for throwing event who is physically able to throw. This year we will only list those you have checked. No additions will be made the day of the games. NO EXCEPTIONS! Also, residents may only register for one racing category. The resident must be entered in the appropriate race. If they use a walker daily at your facility, they would be appropriate for the walker race and so forth. No knee walkers will be allowed. NO EXCEPTIONS! Dominoes competition has been eliminated from the Games for Life. We intend to make it a separate event on a different day. You may register a maximum of 12 participants who are physically participating in the games. Each facility will be allowed a maximum of 10 arts & crafts entries. Use a separate form for those with crafts who are NOT attending.Participant NameSexDate of BirthAgeUses a Wheelchair?Throwing50’ Unassisted Race50’ Cane/Walker Race50’ Wheelchair RaceSpellingVolleyballNumber of Arts & Crafts FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? FORMTEXT ????? FORMTEXT ? FORMTEXT ????? FORMTEXT ??? FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMCHECKBOX FORMTEXT ? ................
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