ONTARIO HIGH SCHOOL RODEO ASSOCIATION
2009 – 2010 OFFICIAL RODEO ENTRY FORM
HILLSBURGH QUALIFYING RODEOS – 10 AM & 1 PM RODEOS (TWO QUALIFYING RODEOS)
Location of Rodeo: Gray’s Arena, 5677 3rd Line, Hillsburgh, ON
Date: Saturday, September 26, 2009 Performance Times: 10:00 am & one hour following the first perf
Membership # ____________ Contestant Name: _________________________________________________________________
Mailing Address: __________________________________________________________________________________________
City Prov. Postal Code
Phone #: ( )________________ Age: _________ Grade: _________ E-mail:__________________________
High School __________________________________________________ Phone # (____)_____________________
Check each event that you are entering for this rodeo.
PARENT OR GUARDIAN’S COMPLETE SIGNATURE MUST APPEAR OPPOSITE EACH EVENT ENTERED
High School Boys Events High School Girls Events
Calf Roping______________________________ Barrel Racing_________________________________
Steer Wrestling___________________________ Breakaway Roping_____________________________
Saddle Bronc Riding_______________________ Goat Tying___________________________________
Bareback Riding __________________________ Pole Bending_________________________________
Bull Riding_______________________________ Team Roping_________________________________
Team Roping___________________________Team Roping – Circle your position: Header / Heeler Partner’s Name: _______________
Junior High Boys Events Junior High Girls Events
Calf Roping or Breakaway (circle one)______________ Barrel Racing_________________________________
Chute Dogging ____________________________ Breakaway Roping_____________________________
Boys Goat Tying ________________________ Goat Tying___________________________________
Bull/Jr. Steer Riding________________________ Pole Bending_________________________________
Ribbon Roping ___________________________ Ribbon Roping _________________ Partner’s Name:________________
Team Roping______________________________ Team Roping – Circle your position: Header / Heeler
Partner’s Name: _______________________
1st RODEO 2nd RODEO
OHSRA ($50.00) and Scholarship Fund ($6.00) $ __56.00_ $ __56.00_
ENTRY FEE: $15.00 X____ (number of) EVENTS $ ________ $ ________
TOTAL DUE AND TOTAL AMOUNT ENCLOSED $ ________ + $ ________ = $ _________
Contestant’s Signature: ____________________________________________________________
WAIVER OF LIABILITY
We, the parents /guardians of _______________________________ (contestant) give the nearest hospital permission to administer necessary emergency treatment for
injuries he or she may incur while participating in the Ontario High School Rodeo. We understand that each contestant must be and is covered by medical insurance.
We hereby release the hospital, physicians on the medical staff, and the rodeo sponsors from all liability except for negligence. We also do hereby release and discharge
the stock contractors, property owners and the Ontario High School Rodeo Association, its officers, agents and employees from any and all claims, demands, damages,
suits, actions or causes of actions which may or can be suffered by said son or daughter while participating in the said High School Rodeo or from any claims, demands,
suits, actions or causes of actions which may be suffered by myself or by a family member while assisting before, during and after said rodeo. This release is complete
and full and is not contingent upon any act, work, or deed by either the undersigned or the sponsoring bodies and individuals of said rodeo.
_______________________________ (Fathers signature) and _______________________________ (Mother’s signature)
CERTIFICATE OF ELIGIBILITY
I, the undersigned, do hereby certify that _______________________________________, (name of student), is enrolled in __________________________High
School and has made passing grades in four (4) subjects, or if carrying less than 4 subjects, has passing grades in all subjects and meets all conduct requirements.
Dated this ________day of _____________________________.
Signature of School Principal/Vice-Principal Phone or E-mail
Entries are due in to Michelle Stacheruk via email/mail/fax by Monday, September 21, 2009. Please make cheque payable to OHSRA or bring to event.
Faxed entries may be sent to 705-277-2381. Deadline for faxes is Monday, September 21, 2009. Please NO faxes or phone calls before 9am!!!
Please check if you would like to be notified via e-mail that your entry was received. E-mail address__________________________________
Completed entry forms and cheque should be sent to: OHSRA c/o Michelle Stacheruk, 492 Wilmont Rd., Pontypool, ON L0A 1K0
Phone: 905-432-5980 Email: firstname.lastname@example.org Website: www.ohsra.ca