Southeast Texas Barrel Racing Association

SOUTHEAST TEXAS BARREL RACING ASSOCIATION

2018 RELEASE FORM

STBRA Member? (Please circle one) Yes No

Name: ______Date: ______

PLEASE COMPLETE A SHORT FORM FOR EACH HORSE ENTERED IN EACH CLASS

# Entries Class Fee Each Total Fee

______Exhibition Barrels (60 second time limit) $5.00 $______

______Open 5D Barrels $30.00 $______

______Pee Wee Barrels (6 & Under) $15.00 $______

Carry over to Open 5D? Yes No

Carry over to Youth 3D? Yes No

______Youth 3D Barrels (18 & Under) $20.00 $______

Carry over from 5D? Yes No

______35 & Over 3D Barrels $20.00 $______

Carry over from 5D? Yes No

______$1000 Novice Horse 3D Barrels $20.00 $______

Carry over from 5D? Yes No

______Exhibition Poles (90 second time limit) $5.00 $______

______Open 3D Poles $20.00 $______

______Youth 3D Poles (18 & Under) $20.00 $______

Carry over from 3D? Yes No

______$1000 Novice Horse 3D Poles $20.00 $______

Carry over from 3D? Yes No

______ Buckle Series Carry Over from Open 5D $10.00 $______

Tractor fee $5.00 $______5.00

TOTAL ENTRY FEES $______

State of Texas - Hold Harmless Release Agreement

From this day forward, I, ______do hereby release Southeast Texas Barrel Racing Association, and all officers and directors thereof, as well as sponsors, arena owners, and other persons or entities in cooperation with Southeast Texas Barrel Racing Association from any and all liabilities for injuries or damage of any kind to me, my minor children and my property incurred while participation in or observing any activities of said organization. I execute this General Release and Consent Agreement with full knowledge of the risk inherent in such events and admit such risks are voluntarily assumed by me, individually and on behalf of my minor children.

Signature ______Date ______

Address ______

City ______State ______Zip ______

Phone Number ______Email ______

**CASH ONLY FOR ENTRY FEES - $1.00 CHARGE FOR ALL WINNINGS MAILED**