California High School Rodeo Association - District 2 DATE: Jan. 16-18th , 2009 Location: Lakeport, CA. (Lake County Fairgrounds) Entries Close: Jan. 7th, 2009 MUST BE POSTMARKED BY CLOSING DATE! CONTESTANT NAME:___________________________________________________________ Cutting CHECK IN: 6:30 pm Friday Mail Entries to: Cutting: 7:00 pm – Friday Afternoon Stephanie Wheeler P.O. Box 847 CHECK IN: 7:00 to 8:00 am Saturday Laytonville, CA 95454 Rodeo: 9:00 am Saturday 9:30 am Sunday 707-272-3283 Make checks payable to: CHSRA Dist.2 MANDATORY MEETING: 8:00am Sunday Please place a check mark next to the event you wish to enter and also a check mark next to Jackpot (if you wish to enter for that event!) Jackpot Jackpot ____ Bull Riding ($72) ______($10) ____Pole Bending ($22) ______($10) ____ Bareback ($72) ______($10) ____Barrel Racing ($22) ______($10) ____ Saddle Bronc ($72) ______($10) ____Breakaway ($42) ______($10) ____ Tie Down Roping ($42) ______($10) ____Goat Tying ($22) ______($10) ____ Steer Wrestling ($42) ______($10) ____Girls Cutting ($42) ______($10) ____ Boys Cutting ($42) ______($10) ____ Team Roping ($42) ______($10) Total Event Fees _________ Partners Name_______________________________ Total Jackpot Fees _________ *For points purposes PLEASE indicate Stall Fees_________ Office/Ambulance Fee - $20.00 if you are a Header or Heeler (circle one) TOTAL FEES ________ A $5.00 fee for incomplete or incorrect entries will be charged! “We the parents or guardians of ____ (name of contestant) give the Sutter Lakeside Hospital and physicians on the medical staff of the Hospital, permission to administer Necessary Emergency treatment for injuries he/she may incur while participating in the CHSRA District #2 Rodeo. We understand that each contestant must be and is covered by medical insurance. We hereby release the Sutter Lakeside Hospital, its physicians on the Medical staff and the Rodeo Sponsors from all Liability.” SIGNED: (Parent or Guardian Must Sign, regardless of age of contestant) Contestant Signature _____ Membership # District #_____ Address City ____ Zip _____ Telephone _____ Grade Age Name of High School For School Official Validation: “I do certify that this student meets both NHSRA Grade and Conduct qualifications (Must have passing grades in minimum of 4 classes, if carrying less than 4 classes, must have passing grades in all) AND CHSRA Requirements, which are: student has at least a 2.0 GPA as of the latest “GRADING PERIOD” (Grading Period must cover 6 weeks or more) (Grading Period: Quarter, Semester, or “Progress Reports” mailed home that are generated 6 weeks or more with ALL current grades and mailed to ALL students) (No “walk around” grades accepted!) Student must be in good standing; not ruled undesirable for misconduct at school. SIGNED: PHONE # Principal or Counselor (Place School Stamp or Seal over Signature) THE RELEASE BELOW MUST BE COMPLETED AND RETURNED WITH ENTRY FORM We the undersigned hereby release the Lake County Fairgrounds, City of Lakeport, West Coast Rodeo company; its officers and employees; all members of CHSRA, and any and all persons associated with the above said Rodeo from all liabilities, losses or damages to rider or property. We hereby give permission for the designated first aide person; Hospital and Physicians of the medical staff of the Hospital to administer necessary emergency treatment for injuries he or she may incur while at the above said Rodeo. Signature of Parent or Legal Guardian________________________________ Date_____________________________ Signature of Contestant_____________________________________________ Date_____________________________ List NEW sponsors since last rodeo: __________________________________________________________________________ __________________________________________________________________________ ___________________________________________ *NO LATE ENTRIES WILL BE ACCEPTED (all entries will be returned unopened if postmarked after due date) *Membership cards required at check-in *Contestants must be C.H.S.R.A. member in good standing *Set-ups: Form at the bottom of this sheet. All set-up forms must accompany rodeo entry. Form must be completed in its entirety. SET-UP FORM (Only fill out if you need a set-up for this rodeo) Reason for Rodeo Set-up: ________________________________________________________________ Date of School Function: ________________________________________________________________ School Contact and Phone No.: _____________________________________________________________ Signature of: School Athletic Director (for High School Team Sports Function) OR Principal or Counselor (if test or other School Related Function) MUST place School Seal or Stamp Over Signature Signature: ________________________________________________ (Signature of Principal or Relevant School Official) *Contact name at school must be completed. (He/She will be contacted by the rodeo secretary to verify function and date.) *Set-ups are for high school functions only. Contestant must be a valid member of a school team, contest or test activity occurring on the date of this rodeo. *Set-ups are for Saturday (or 1st go): meaning both goes run on Sunday or 2nd go. *Sunday set-ups will be accepted only if there are no contestants needing a Saturday set-up. *Set-ups will be run prior to the start of the 2nd go round. Stock and positions will be drawn for set-ups just the same as other contestants.
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