Holmen Entry Form – Two Go

Rodeo Dates – July 4 & 5th, 2015 To avoid late entry penalties; entry form must be post marked on or before June 22, 2015

Contestant’s Name


LBW #

Address City State Zip

Home Phone Number Cell Number (s) _Email Address

Date of Birth Age as of January 1st

Your age group will be determined by the age you were as of January 1, 20145 If you are 6 years old as of May 9, 2015 you are eligible for the 2015 rodeo season.

The undersigned parent or guardians of the applicant who has signed the foregoing application for entrance in sanctioned Little Britches of Wisconsin, LTD at Holmen, WI, personally appeared before me and upon their oath deposes and say that permission is hereby given for said applications to participate in said rodeo and agrees to hold the Little Britches of Wisconsin, LTD and sponsor Coulee Rodeo Club harmless from any and all liability whatsoever by reason of his or her attendance or participation in said rodeo. Contestant will receive a pass for all rodeo events. We as parents agree that all other members of our family will pay the regular admission price to view the rodeo, as in the case in all other sporting events.

Applicant’s Signature Parent’s Signature

Subscribed and sworn before me this day of 2015 Commission expires

Notary Public in State of Wisconsin

Two Go – Please select either day or both days per event. (Be sure to select both Saturday and Sunday if competing both days.)

Events / Gender / Age / Saturday / Sunday
Barebacks / Boys / 6 - 11 / ⃝ / ⃝
Barebacks / Boys / 12 - 13 / ⃝ / ⃝
Barebacks / Boys / 14 - Over / ⃝ / ⃝
Bullriding / Boys / 6 - 11 / ⃝ / ⃝
Bullriding / Boys / 12 - 13 / ⃝ / ⃝
Bullriding / Boys / 14 - Over / ⃝ / ⃝
Saddle Bronc Riding / Boys / 13 - Over / ⃝ / ⃝
Goat Tying / Boys / 6 - 12 / ⃝ / ⃝
Tie Down Roping / Boys / 13 - Over / ⃝ / ⃝
Steer Wrestling / Boys / 13 - Over / ⃝ / ⃝
Chute Dogging / Boys / 6 Years - 8th Grade / ⃝ / ⃝
Barrels / Girls / 6 - 12 / ⃝ / ⃝
Barrels / Girls / 13 - Over / ⃝ / ⃝
Pole Bending / Girls / 6 - 12 / ⃝ / ⃝
Pole Bending / Girls / 13 - Over / ⃝ / ⃝
Goat Tying / Girls / 6 - 12 / ⃝ / ⃝
Goat Tying / Girls / 13 - Over / ⃝ / ⃝
Breakaway Roping / Girls / 13 - Over / ⃝ / ⃝
Breakaway Roping / Open / 6 - 12 / ⃝ / ⃝
Team Roping - Header / Open / 6 - Over / Partner / ______/ ⃝ / ⃝
Team Roping -Heeler / Open / 6 - Over / Partner / ______/ ⃝ / ⃝

Check or Money Order payable to LBW must accompany completed entry forms. Entry Fee is $10 per run/ride.

O Previous Family Membership Paid O Enclosed Family Membership $50

Copy of Negative Coggins required. Check-in Deadline is 10:00AM – No Late Check-ins Allowed.

Entry Forms should be mailed to: Michelle Rud,W881 County Road A , Mondovi, WI 54755