California High School Rodeo Association

California High School Rodeo Association - District 2

DATE: October 21st, 22nd & 23rd 2011 Location: Potter Valley, CA. (Rodeo Grounds) th Entries Close: Oct. 7 , 2011 MUST BE POSTMARKED BY CLOSING DATE!

CONTESTANT NAME:______

ALL CONTESTANTS MUST VIEW SAFETY VIDEO PRIOR TO FIRST RODEO PERFORMANCE Friday: Cutting Stan Fonsen’s 10257 Main St., P.V. Mail Entries to: Cutting check in 3 pm, Cutting at 4pm Shani Smith Sat.: Check in: 7:00 to 8:00am 9701 Laughlin Way MANDATORY MEETING: Sunday 8am Redwood Valley, Ca. 95470 Rodeo: Saturday & Sunday 9:00am (707) 272-1968 or (707) 485-8829

Please place a check mark next to the event(s) you wish to enter Total Event Fees ____ Bull Riding ($68) ____Pole Bending ($25) Office/Ambulance Fee 20.00 ____ Bareback ($68) ____Barrel Racing ($25) ____ Saddle Bronc ($68) ____Breakaway ($45) TOTAL FEE’S ____ Tie Down Roping ($45) ____Goat Tying ($25) ____ Steer Wrestling ($45 ____Girls Cutting ($45) Checks payable to: CHSRA Dist.2 ____ Boys Cutting ($45) ____Team Roping ($45) ____Requesting a ghost roper ($10)

ROPERS: PLEASE indicate if you are a [ ]Header [ ]Heeler Partners Name______Enter in ghost roping pool [ ]Yes [ ] No [ ] Header [ ]Heeler

You will receive a $5.00 fee or a Trash Bag for Incomplete or Incorrect Entries!

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 5 weeks or more) (Grading Period: Quarter, Semester, or “Progress Reports” mailed home that are generated 5 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: Date: PHONE # Principal or Counselor (Place School Stamp or Seal over Signature) *Set-ups: Form on the back of this sheet. All set-up forms must accompany rodeo entry. Form must be completed in its entirety including signed and stamped by school.

*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

THE RELEASE BELOW MUST BE COMPLETED AND RETURNED WITH ENTRY FORM

“We the parents or guardians of (name of contestant) give the Ukiah Valley Medical Center 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 Ukiah Valley Medical Center, its physicians on the Medical staff and the Rodeo Sponsors from all Liability.”

We the undersigned hereby release the Potter Valley Community Parks, Potter Valley Fire, 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.

 SIGNED: (Parent or Guardian Must Sign, regardless of age of contestant)

Contestant Signature _____ Membership # District#_____

Address City ____ Zip Telephone - Grade Age

E-Mail Address______

List NEW sponsors since last rodeo: ______

SET-UP FORM (Only fill out if you need a set-up for this rodeo, both places must be signed & stamped)

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. *Set-ups are for high school functions only. He/She will be contacted by the rodeo secretary to verify function and date

Contestant must be a valid member of a school team, contest or test activity occurring on the date of this rodeo. Dances are not included. *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.