2015 illinois rough stock & barrel racing series - C

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Mail to:
Illinois Rough Stock & Barrel Racing Series
9205 State Route 37
Kinmundy, IL 62854
(Checks made payable to IRBS - Nonrefundable)
E-mail:
[email protected]
2015 ILLINOIS ROUGH STOCK & BARREL RACING SERIES
CARDHOLDER APPLICATION
Check all that Apply (Maximum Cardholder Fee is $150)
____ BULL RIDING – $150
____ JR. BULL RIDING – $100 (Age Limit – 14 yrs old)
____ ANNOUNCER – $100
____ JUDGE – $100
____ COWGIRLS BARREL RACING – $150
____ BULLFIGHTER – $100
____ FUNNY MAN – $100
**$25 of cardholder fee goes toward year end finals awards (refundable upon sponsorship received)**
If under 18 years old – SIGNED RELEASE REQUIRED – Must be notarized.
See back of form
NAME: __________________________________________________________ DATE OF BIRTH: ______________________
ADDRESS: ____________________________________________________________________________________________
CITY: _______________________________________________ STATE: _________________ ZIP CODE: ________________
HOME PHONE: _____________________ CELL PHONE: _____________________ WORK PHONE: _____________________
SSN#: ______________________________ E-MAIL ADDRESS: __________________________________________________
JACKET SIZE: _______________________________________ T-SHIRT SIZE: _______________________________________
LIST AWARDS, HONORS, HOBBIES, ETC._____________________________________________________________________
I, the undersigned, being of age 18 years, do hereby assume the full and complete responsibility for any loss, damage, or injury, which I may suffer, to my person or property in
connection with the ILLINOIS ROUGH STOCK & BARREL RACING SERIES.
I, the undersigned, do hereby release and forever discharge the C-Bar Rodeo Co., its Founders, Event Directors, Contractors, Personnel and all other persons, firms or
corporations liable or who might be claimed to be liable from any and all claims, demands, damages, actions or suits of any kind or nature whatsoever on account of any injuries
both to person or property which I may suffer while riding at any C-Bar Rodeo Co. function and engaged in activities thereof or from the use of any stock or equipment, or from
entering or being upon the premises upon which said rodeo is taken place.
The undersigned acknowledges that he or she is aware that attendance at said arena and engaging in the activities thereof involve a certain amount of danger and that the
terms of this release have been completely read and are fully understood by the undersigned.
In witness whereof, the undersigned had hereunto set his or her hand this current C-Bar Rodeo season. I am aware that Bull Riding and Barrel Racing are very dangerous and can
lead to severe injuries or even death.
FOR OFFICIAL USE ONLY
____________________________________________________________________________
Signature
Date
____________________________________________________________________________
Witness of Signature
Date
AMT. REC’D _______________
METHOD OF PMT _______________
CARD NO. _______________
DATE REC’D _______________
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4/14/2015
MINOR RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT
C-Bar Rodeo Co. / Illinois Rough Stock & Barrel Racing Series
(For cardholders under 18 years of age)
THE UNDERSIGNED PARENTS OR LEGAL GUARDIANS HAVE READ AND VOLUNTARILY SIGN THE MINOR RELEASE AND
WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS,
STATEMENTS OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.
WE APPRECIATE AND ASSUME ALL RISKS INHERENT IN RODEO.
X ______________________________________
Signature of Parent or Legal Guardian
AND
X ________________________________________
Signature of Minor
On this _______ day of ______________________ 20 ______, before me, personally appeared
_________________________________________________
to me known to be the persons who executed the foregoing Release and acknowledged that they signed same as their free act and
deed.
X________________________________________
Notary Public
___________________
My Commission Expires:
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4/14/2015
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