2007-2008 YOUTH MEMBERSHIP
APPLICATION
(5TH
GRADE & UNDER)
COPY OF REPORT CARD REQUIRED
BOY:
____GIRL: ____ MAKE CHECKS PAYABLE TO: THSRA –
REGION III
NEW:
____RENEWAL: ____ PLEASE WRITE ONE CHECK ONLY FOR
APPLICATION
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NAME |
ADDRESS |
CITY, ZIP |
PHONE NUMBER |
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FATHER’S NAME |
MOTHER’S NAME |
EMAIL |
CELL PHONE |
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GRADE |
AGE |
DATE OF BIRTH |
WORK NUMBER |
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PLEASE CHECK EVENT
OR EVENTS YOU WILL COMPETE IN:
_______CALF RIDING (BOYS ONLY) ________BARRELS
_______BREAKAWAY ROPING ________POLES
_______GOAT TYING ________TEAM ROPING
“We
the parents or guardians of______________________________, give permission for
our son or daughter to participate in the THSRA REGION III rodeos for the
2007-2008 rodeo season. By signing this membership form we hereby release the
HOSPITAL, PHYSICIANS ON THE MEDICAL STAFF, THSRA-REGION III ASSOCIATION AND THE
BOARD OF DIRECTORS from all liability that he or she may incur while
participating in the THSRA – REGION III OFFICIALLY APPROVED RODEOS.
____________________________________________________ _________________________________________
(PARENT
OR LEGAL GUARDIAN MUST SIGN) DATE
THE
STATE OF TEXAS
COUNTY
OF_________________________
On
this ______________day of____________________________2007, BEFORE ME,
personally appeared ____________________________________, to me known to be the
parent or legal guardian of_____________________________________________and
signed the foregoing instrument in my presence.
My
commission Expires: ______________________
___________________________________________
Office
use only:
Date________________Payment___________________Amount_______________