2006-2007 IJRA Application/Permission Form
Contestant: ________________________ Parent(s)/Guardian(s):_________________________ Date of Birth: ____________ Grade: ____ Phone: ( ) ______________ E-Mail _____________ Address: ______________________________________________________________________ Street City State Zip Code The signatures below MUST initial each appropriate age division.
K-1-2 Boy or Girl 3-4-5 Boy or Girl Steer Daubing Steer Daubing Goat Tying Goat Tying Breakaway Roping Breakaway Roping Calf Riding Calf Riding Mutton Busting _____________ Step Down Roping ______________ Chute Dogging Initial Chute Dogging Initial Barrel Racing Barrel Racing Pole Bending Pole Bending Bale Roping – Calf Head* Bale Roping – Steer Head*
6-7-8 Boy 6-7-8 Girl Steer Daubing/Chute Dogging Goat Tying Tie-Down Calf Roping Breakaway Roping Calf Riding ____________ Barrels _______________ Breakaway Roping Initial Pole Bending Initial Team Roping Team Roping Calf Riding Steer Daubing/Chute Dogging
6-7-8 Grade Only - We the parents of _______________________give our permission for them to haze in Steer Daubing.
My daughter/son is under the custodial care of (check one):
Both Parents ____ Mother Only ____ Father Only ____ Guardian(s) ____
Parent(s) or Legal Guardian Signatures
________________________________ & _________________________________
We, the parent(s) or guardian(s), give our permission for said contestant to participate in said rodeo(s) and agree to hold Indiana Junior Rodeo Association unaccountable for any liability whatsoever resulting from his/her participation in said rodeo(s). We the parent(s) or guardian(s) of __________________________ (contestant), give the local 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 a Junior Rodeo. We understand that each contestant must be and is covered by medical insurance. We hereby release the local hospital and physicians on the medical staff, and the rodeo sponsors from all liability. We agree to pay the $50 deductible on our son/daughter’s insurance medical claims.
Given under my hand and official seal this __________ day of ___________________ 20___.
My Commission expires _______________________ County of ________________________
__________________________________
Notary Public
