Va Form 0926b - National Veterans Golden Age Games Athlete Application - 2012 Page 2
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1
2ATHLETE NUMBER-OFFICE USE ONLY
ATHLETE EVENT SELECTION
ATHLETE'S NAME (Please print)
GENDER
AGE (as of May 31, 2012)
55-59
60-64
65-69
MALE
FEMALE
70-74
75-79
80-84
85+
DIVISION CLASSIFICATION - I WILL BE COMPETING IN THE FOLLOWING DIVISION (Check only one)
VISUALLY IMPAIRED (Legally Blind)
AMBULATORY
WHEELCHAIR
WHEN YOU REGISTER IN ONE DIVISION, YOU MUST REGISTER ALL EVENTS IN THAT DIVISION
Check at least two, but not more than four events. When Athletes are scheduled for two events with conflicting times, attend the
Tournament events first. Otherwise, the Athlete will be disqualified for failure to report for the event on time. *Indicates qualifying event
for 2013 National Senior Games. DO NOT schedule conflicting events!
FRIDAY, JUNE 1, 2012
*SHOT PUT
*DISCUS
*JAVELIN
*SHUFFLEBOARD
CHECKERS
ALL ATHLETES
AMBULATORY
AMBULATORY
AMBULATORY
AMBULATORY
WHEELCHAIR
ONE DIVISION
VISUALLY IMPAIRED
WHEELCHAIR
WHEELCHAIR
WHEELCHAIR
8:00 a.m.
55-59
8:00 a.m. - Noon
8:00 a.m. - Noon
8:00 a.m. - Noon
10:00 a.m. 65-69 & 80-84
Noon
65-69
1:00 p.m.
60-64 & 85+
1:30 p.m.
75-79
3:00 p.m.
70-74 & 75-79
2:30 p.m.
55-59
SATURDAY, JUNE 2, 2012
*BOWLING
*SHUFFLEBOARD
CROQUET
AMBULATORY DIVISION ONLY
AMBULATORY
VISUALLY IMPAIRED
AMBULATORY
WHEELCHAIR
WHEELCHAIR
WHEELCHAIR ADAPTIVE
VISUALLY IMPAIRED
8:00 a.m.
65-69
1:00 p.m.
60-64
Starts at 8:00 a.m.; Ends at 5:00 p.m.
8:00 a.m.
60-64
9:00 a.m.
70-74
2:00 p.m.
80-84 & 85+
Wheelchair athletes must throw bowling ball while
10:30 a.m.
80-84 & 85+
10:00 a.m .
75-79
3:00 p.m.
55-59
sitting in wheelchair without the use of adaptive
equipment; Wheelchair Adaptive athletes may use ramp,
1:00 p.m.
70-74
handle ball or stick for assistance.
SUNDAY, JUNE 3, 2012
*GOLF
GOLF
AIR RIFLE
DOMINOES - ALL ATHLETES
AMBULATORY & WHEELCHAIR
ONE DIVISION
AMBULATORY (18 Holes)
VISUALLY IMPAIRED (9 Holes)
ATHLETES ONLY - ONE DIVISION
8:00 a.m.
60-64 & 70-74
Starts at 8:00 a.m.; Ends at 1:00 p.m.
Starts at 9:00 a.m.; Ends at 1:00 p.m.
Starts at 8:00 a.m.; Ends at 5:00 p.m.
10:00 a.m.
65-69
All golfers must bring their own clubs.
All golfers must bring their own clubs.
1:00 p.m.
55-59 & 75-79
3:00 p.m.
80-84 & 85+
MONDAY, JUNE 4, 2012
*HORSESHOES
9-BALL
*SWIMMING
TRAPSHOOTING
EXHIBITION EVENT
AMBULATORY
AMBULATORY
ALL ATHLETES
AMBULATORY
WHEELCHAIR
WHEELCHAIR
WHEELCHAIR
8:00 a.m.-11:00 a.m.
VISUALLY IMPAIRED
8:00 a.m.
65-69
NOTE: May select no more than two swimming events which
1:00 p.m.-4:00 p.m.
will count toward two of the total of four events that are allowed.
8:00 a.m.
60-64
10:00 a.m.
55-59
Starts at 3: p.m.; Ends at 6:00 p.m. (All age groups)
10:00 a.m.
75-79
11:00 a.m.
80-84 & 85+
Noon
70-74
1:00 p.m.
60-64
FREESTYLE 25 YARD
BACKSTROKE 25 YARD
1:00 p.m.
65-69
2:00 p.m.
75-79
FREESTYLE 50 YARD
BACKSTROKE 50 YARD
2:00 p.m.
55-59
3:00 p.m.
70-74
3:00 p.m.
80-84 & 85+
TUESDAY, JUNE 5
CYCLING
*TABLE TENNIS
TRAPSHOOTING
AMBULATORY DIVISION ONLY
EXHIBITION EVENT
AMBULATORY
WHEELCHAIR
ALL ATHLETES
8:00 a.m. 1/4 Mile
8:00 a.m.
60-64
11:30 a.m.
75-79
8:00 a.m.-11:00 a.m.
10:00 a.m. 1/2 Mile
9:30 a.m.
65-69
1:00 p.m.
55-59 & 70-74+
1:00 p.m.-4:00 p.m.
Appropriate footwear must be worn.
10:30 a.
80-84 & 85+
VA FORM 0926b, OCT 2011, page 2
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