POTTER VALLEY

PO BOX 68 PHONE: (707) 743-1742 POTTER VALLEY, CA 95469 www.pottervalleyrodeo.com EMAIL: [email protected]

Gymkhana & Playday Monday, May 29, 2017 9:00 am Name: ______Mailing Address: ______State: ______Zip: ______Email: ______Age: ______Phone Number: ______Name of : ______Emergency Contact Name and Number: ______

• Each contestant needs to send in an Entry Form with the Participation Agreement signed on page 2. • Dress Code: Pants and boots! • Check-in and post entries will be taken at 8:00 am. • Entries must be paid in full. Please make checks payable to: Potter Valley Rodeo • No refunds. • Please send entry, signed Participation Agreement and payment to : Potter Valley Rodeo  Questions? Call Becky Lawson at (707) 621-2395 Attn: Gymkhana PO Box 68 Potter Valley, CA 95469

Hi Point Events: Leadline (No Hi Point):

Pole Bending (Washington) $6.00 Fee: ______Crawl Through Barrel $6.00 Fee: ______

Pole Bending (California) $6.00 Fee: ______Barrel Racing $6.00 Fee: ______Barrels $6.00 Fee: ______Birangle $6.00 Fee: ______

Jackpot (No Hi Point): Big M $6.00 Fee:______

Jackpot Barrels $20.00 Fee: ______Playday Events (No Hi Point): Jackpot Poles $20.00 Fee: ______Ribbon Race $6.00 Fee: ______Partner:______Payout: 50% for 1st, 30% for 2nd, 20% for 3rd Speed Ball $6.00 Fee: ______

Apple Bobbing $6.00 Fee: ______Total Event Fees Due: $______POTTER VALLEY RODEO

PO BOX 68 POTTER VALLEY, CA 95469 PHONE: (707) 743-1742 www.pottervalleyrodeo.com EMAIL: [email protected]

POTTER VALLEY COMMUNITY PARKS & RECREATION PARTICIPATION AGREEMENT At The Potter Valley Rodeo Arena, and Parade areas

I, the undersigned, agree as a condition of participation in any activity in this arena, to release save harmless, defend, protect, and indemnify any person and/or organization (including but not limited to the Potter Valley Community Expo, Inc., the directors of any of those corporations, all committees and sponsors, their representatives and successors) in any way associated therewith and there agents, members, officers, and directors from loss, damage or liability of any sort arising out of or in any way relating to my participation in said Parade, Rodeo, Roping, Drill Team, or Gymkhana activity. If the participant is a minor the undersigned parent or guardian acknowledges that they have read this Agreement and agrees to be bound by its terms as a releaser and as a guarantor and indemnitor of said persons and/or organizations and their agents, members, officers and directors, for the minor and in the minor's place and stead. I waive ALL RIGHTS which I now or may have by virtue of Section 1542 of the California Civil Code which reads: "A general release does not extend to the claims which a creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him, must have materially affected his settlement with the debtor" I know that being in a rodeo can be a potentially hazardous activity. I assume all risks associated with this event, including but not limited to falls, injury to myself, my child, or my horse, etc. Having read this waiver and knowing these facts and in consideration of your accepting my entry. I, for myself or for my child and anyone entitled to act on my behalf waive and release the Potter Valley Community Expo, Inc., a California Non Profit Public Benefit Corporation, the directors and all sponsors, their representatives and successors from all claims or liabilities of any kind arising out of my participation or my child's participation in the rodeo and other activities even though that liability may arise out of negligence or carelessness on the part of the persons/groups named in this waiver.

Contestant / Parent Signature: ______(If under 18 years old parent or guardian MUST sign here or entry will not be accepted)