Office use:
Date received___/___/10 Amount paid $_____Amount due $____ Check #_____Cash__
Name
__________________________________________________ New student_____Returning student_____ Chute Dogging______Steer Wrestling____Birthdate
_____________________AGE________Grade in school________ # of years steer wrestled________Address__________________________City, State, Zip_____________________
Phone #_________________________cell________________email__________________________
Below needed case of injury:
Emergency phone # (during hours of school) ___________________________________
Medical insurance info___________________________________________________
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For all students:
I, (name)_______________________________expressly waive and release any and all claims which I may have now or in the future against Paul Cleveland &/or Todd Suhn, or any other person or organization involved in the "Spring Vacation Steer Wrestling School 2010" conducted by Paul Cleveland, Todd Suhn, Brady Hageman and Garrett Nokes. This provision shall be binding upon each steer wrestling school participant, his spouse, his family members, legal representatives, heirs, successors, and assigns.
Signature of participant_________________________________________
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If participant is under 21 years of age the following consent form must be completed as well as above
:I(We) the parent(s), legal guardian(s) of _________________________, steer wrestling school participant, do hereby swear and affirm that the information provided above is true and correct and hereby release and waive the participation of applicant in the steer wrestling school; and further do hereby release and waive any and all claims for personal injury or any other claim which I (We) may have, now or in the future, against Paul Cleveland, Todd Suhn,Brady Hageman or Garrett Nokes, Keith Co. Fairgrounds, or any other person(s), or any other organizations involved in the steer wrestling school conducted by Paul Cleveland, Todd Suhn, Brady Hageman or Garrett Nokes arising out of or in connection with participation of applicant in the steer wrestling school.
Signature of both parents and legal guardian(s)
_______________________________________ _____________________________________
SUBSCRIBED and sworn to me this____day of ____________, 2010
State of_______________County of________________
NOTARY PUBLIC_____________________________________ (seal)