Contestant Name Card # District

California High School Rodeo Association District #3

______Contestant Name Card # District ______Address City Zip Code ______Phone # School Attending

I certify that this student meets National High School Rodeo Association’s GRADE AND CONDUCT qualifications. (Current grade and conduct requirements only). CHSRA Requirements: Student has at least a 2.0 GPA as of the latest “Grading Period” (covering 5 or more weeks) including a Quarter, Semester, or Progress Reports mailed home that are generated with all current grades and mailed to all students. No “Walk Around” grades accepted. NOTE: Student must be in good standing; not ruled undesirable for misconduct at school.

______Signature of Principal or Counselor Position or Title Date Stamp or Seal of School

“We, the parents or guardians of:______(Name of contestant) give the Sutter Roseville Medical Center and the Physicians on the Medical Staff of the Hospital permission to administer NECESSARY EMERGENCY treatment for injuries he or she may incur while participating in the California High School Rodeo, District #3 High School Rodeo. We understand that each contestant must be and is covered by medical insurance. We hereby release the Roseville Community Hospital, physicians on the Medical Staff and the Rodeo Sponsors from all Liability except for negligence. We the Undersigned also do hereby release the Lincoln Riders Club, Colby Camacho Rodeo Company, California High School Rodeo Association, all rodeo sponsors and any and all persons associated with the above from liabilities, losses or damages to rider or property.

Signed:______(Parent or guardian must sign for each event entered, regardless of age of contestant.)

Signed:______(Contestant) This form must be signed, dated and sent to: CHSRA D3 5314 Smith Road, Oakdale, CA 95361

by close of entries for the rodeo you are entering. ***** February Rodeo………This Document needs to be Postmarked by January 29th!!! No Exceptions.*****