ONTARIO HIGH SCHOOL RODEO ASSOCIATION - DOC

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					                                  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: admin@rawhiderodeo.com Website: www.ohsra.ca
www.ohsra.ca