South East Idaho Rodeo Bible Camp

Circle which camp you plan to attend: Downey, ID Wells, NV Big Piney, WY

CAMPER APPLICATION

Name (Last)______(First)______(MI)______

Address ______City______State____Zip______

Phone______Emergency # other than home______Gender M or F

Birth Date______Age______Email______

Parent’s Name(s)______

**campers are not allowed to have cell phones at camp!

****Registration will begin at 4:30 **

Rodeo Events (mark 1st and 2nd choice with 2 events maximum) PARENTS MUST INITIAL CHOICES

If 1st choice Is rough stock you /// If 1st choice Is from one of these 3 columns

May choose a 2nd rough stock /// you may choose a 2nd event from these columns – (not a rough stock event)

Event to be taught if time allows /// to be taught as time allows

___Bareback /// ___Team Roping Header ___Barrel Racing ___Buckaroo Business

___Saddle Bronc /// ___Team Roping Heeler ___Pole Bending (horsemanship, trail)

___Bull riding/steer riding /// ___Tie Down Roping ___Goat Tying ____Ranch Roping

___Bull Fighting /// ___Chute Dogging ___Breakaway Roping (Wells only)

___ Stock Saddle Bronc Wells & Big Piney only

Only one horse per event, per camper allowed. There are limited stall spaces. Stalls are $10 per horse, ______# of horses.

BRAND INSPECTIONS, VACCINATIONS, ETC.: Out of State horses must have a current Coggin’s test, health certificate and brand inspection. In State horses need proof of ownership to be kept with the camper.

MEDICAL INFORMATION: I have allergies to the following: ______

The following drugs can be given to this camper: ___Tylenol ___Ibuprofen ___Benadryl ___Triple antibiotic ointment

List all prescription drugs that this camper will be taking during camp: ______

List any major medical conditions of this camper: ______

INSURANCE IS REQUIRED

Company______Policy # ______Group # ______

BIRTH CERTIFICATE: Please attach a notarized copy of your birth certificate if this is your first time at this camp.

RELEASE OF LIABILITY:

As the parents/legal guardians of ______(camper), we do hereby give permission for said child to participate in the rodeo events and activities of the S.E. Idaho Rodeo Bible Camp, on scheduled dates of camp. We release their agents, officers, directors, volunteers or any other person acting on their behalf from all claims, demands, action, judgments and executions which the below named ever had, or now has, or may have in the future for all personal injuries or property damage that may be suffered by entry or participation. We have done so fully understanding that rodeo is a hazardous sport which could lead to serious injury and in some cases even death. In giving our permission for said child to participate in the Rodeo Bible Camp, we give permission for any medical treatment that may be necessary and release and understand its significance.

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SIGNATURE OF APPLICANT SIGNATURE OF PARENT

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SIGNATURE OF PARENT

State of ______, County of ______, on this ______day of ______year______before me a notary public in and for the State, personally appeared (applicant)______and (parents/legal guardian(s)) ______and ______

Known to me to be the persons whose names are subscribed to the above named Rodeo Bible Camp and acknowledges to me that they executed the same.

Notary Public______

Residing at______

My Commission Expires______

Please mail completed application and fees to:

South East Idaho Rodeo Bible Camp

P.O. Box 226

Inkom, ID 83245 Secretary’s Phone: 208-244-2017 Director’s Phone: 208-335-2308

ASSUMPTION OF RISK

SOUTH EAST IDAHO RODEO BIBLE CAMP

WELLS NEVADA RODEO BIBLE CAMP

BIG PINEY WYOMING RODEO BIBLE CAMP

I have discussed the event(s) that I wish to participate in with my parents(s) or legal guardian, and they have explained to me the possibility of my being slightly and/or severely injured.

I and my parents(s) or legal guardian are willing to assume the responsibility of possible injury that could result from the event in which I will be participating.

I further agree that should I feel endangered at any point, either by my own actions, the actions of others, or by any surrounding circumstances that I am free to withdraw from the event, and will do so of my own free will.

I am voluntarily foregoing my legal rights against the South East Idaho Rodeo Bible Camp. I voluntarily assume the risk inherent to this event, and that I do so of my own free will.

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Print name of Minor Signature of Minor

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Date

I THE UNDERSIGNED PARENT(S) OR LEGAL GUARDIAN(S) HAVE READ AND VOLUNTARILY SIGN THE ASSUMPTION OF RISK FROM AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.

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Print name of parent/guardian Signature of parent/ guardian

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Print name of parent/guardian Signature of parent/guardian

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Date

PARTICIPANT RELEASE AND WAIVER OF

LIABILITY AND INDEMNITY AGREEMENT

SOUTH EAST IDAHO RODEO BIBLE CAMP

WELLS NEVADA RODEO BIBLE CAMP

BIG PINEY WYOMING RODEO BIBLE CAMP

IN CONSIDERATION of being permitted to enter for any purpose any RESTRICTED AREA (herein defined as including but not limited to the arena, chutes, staging area, approaches thereto and all walkways, concession, and other areas appurtenant to any area where any activity related to the event shall take place), or being permitted to compete, officiate, observe, work for, or for any purpose participate in any way in the event, THE UNDERSIGNED, for himself/herself, his/her personal representative, heirs, and next of kin, acknowledges, agrees and represents that he/she has or will immediately upon entering any of such restricted area or areas and his/her participation, if any in the event constitutes an acknowledgment that he/she is in or about restricted areas and if he/she further agrees and warrants that if, at any time, he/she is in or about restricted areas and if he/she feels anything is unsafe, he/she will immediately advise the SOUTH EAST IDAHO RODEO BIBLE CAMP staff of such and will leave the restricted areas.

1. HEREBY ACKNOWLEDGE, that the SOUTH EAST IDAHO RODEO BIBLE CAMP staff, Board of Directors, promoters, participants, rodeo association, sanctioning organization or any subdivision thereof, arena operator, arena owner, officials, or their participants, any persons in restricted area, promoters, sponsors, advertisers, stock contractors, owners, lessee of premises used to conduct the event and each of them, their officers and employees, all for the purpose therein referred to as “Releasees” are protected by Idaho’s EQUINE ACTIVITIES IMMUNITY ACT and are therefore protected under STATUTORY IMMUNITY and are not subject to legal sanction or liability connected therewith.

2. HEREBY RELEASES, WAIVES, DISCHARGES AND COVENANTS NOT TO SUE the “RELEASEES” from all liability to the undersigned my/our personal representatives, assigns, heirs and next of kin for any and all loss or damage and any claim or demand on account of any injury to the participant included, but not limited to, death whether caused by the negligence of the “Releasees” or otherwise while the minor is in or upon the restricted area and/or competing, officiating in, observing, working for or for any purpose participating in the event.

3. HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the “Releasees” and each of them from any loss, liability, damage or cost they may incur due to the presence of the said minor in or upon the restricted area or in any way competing, officiating, observing, or working for any purpose participating in the event and cause by the negligence of the “Releasees” or otherwise.

4. HEREBY AGREES FULL RESPONSIBILITY FOR AND RISK OF BODILY INJURY, DEATH, PROPERTY DAMAGE due to the negligence of “Releasees” or otherwise in or upon the restricted area or areas and/or while competing, officiating, observing, or working for or any purpose participating in the event.

I, THE UNDERSIGNED, EXPRESSLY ACKNOWLEDGE AND AGREE that the activities of the event are very dangerous and involve the risk of serious injury and/or death and/or property damage. I, THE UNDERSIGNED, further expressly agree that the foregoing release waiver and indemnity agreement is intended to be as broad and inclusive as it is permitted by the law of the State of Idaho and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I, THE UNDERSIGNED, HAVE READ AND VOLUNTARILY SIGN THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIVE, STATEMENTS, OR INDUCEMENTS APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE.

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Signature of Participant Print name Date

PARENTAL OR GUARDIAN RELEASE AND WAIVER

OF LIABILITY AND INDEMNITY AGREEMENT

SOUTH EAST IDAHO RODEO BIBLE CAMP

WELLS, NEVADA RODEO BIBLE CAMP
BIG PINEY WYOMING RODEO BIBLE CAMP

I/WE HEREBY RELEASE, WAIVER, COVENANT NOT TO SUE AND DISHCARGE THE SOUTHEAST IDAHO RODEO BIBLE CAMP, INC. staff, Board of Directors, participants, rodeo association, sanctioning organization or any subdivision thereof, arena operator, arena owner, officials, or their participants, any persons in restricted area, promoters, sponsors, advertisers, stock contractors, owners, lessee of premises used to conduct the event and each of them, their officers and employees, all for the purpose therein referred to as “Releasees,” from all liability to the undersigned my/our personal representatives, assigns, heirs and next of kin for any and all losses or damage and any claim or any demand on account of any injury to the participant included, but not limited to, death whether caused by the negligence of the “Releasees” or otherwise while the minor is in or upon the restricted area and/or competing in, observing, working for or any purpose participating in the event.

The Restricted Area is defined as but not limited to the arena, chutes, staging areas, approaches thereto and all walkways, concessions and other areas appurtenant to any such area where any activity related to the event shall take place.

1. I/WE HEREBY ACKNOWLEDGE, that the “Releasees” as well as the activities and events conducted, supervised, or in any way connected with “Releasees” are protected by Idaho’s EQUINE ACTIVITIES IMMUNITY ACT and are therefore protected under STATUTORY IMMUNITY and are not subject to legal sanction or liability connected therewith.

2. I/WE will inform and instruct the said minor participant that upon entering any restricted area and the minor must continuously thereafter inspect such restricted area and all portions thereof which the minor enters and with which he/she comes in contact and I/WE further warrant that the minor’s entry upon such restricted area(s) and his/her participation, if any, in the event constitutes an acknowledgment that he/she (the minor), has inspected such restricted area and he/she finds and further agrees and warrants that if, at any time, he/she is in or about restricted areas and if he/she feels anything is unsafe, he/she will immediately advise the SOUTHEAST IDAHO RODEO BIBLE CAMP, INC. staff of such and will leave the restricted areas.

3. The undersigned expressly acknowledge and agree that the activities of the event are very dangerous and involve risk of serious injury and/or property damage.

4. Each of the undersigned parent(s) or legal guardian(s) of the minor participant agrees to indemnify and save and hold harmless the “Releasees” and each of them from any loss, liability, damage, or cost they may incur due to the presence of the said minor in or upon the restricted area or in any way competing, officiating, observing, or working for any purpose participating in the event and caused by the negligence of the “Releasees” or otherwise.

THE UNDERSIGNED PARENT(S) OR LEGAL GUARDIAN(S) HAVE READ AND VOLUNTARILY SIGN THE MINOR RELEASE AND WAIVER OF LIABILTY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENATION, STATEMENTS, OR INDUCEMNTS ARPART FROM THE FOREGOING WRITTEN AGREEMET HAVE BEEN MADE.

Parent or Legal Guardian **______Date ______

** IN ORDER TO VALIDATE PARENTAL CONSENT STAFF MAY CONTACT PARENT(S)

OR LEGAL GUARDIAN(S) AT WILL.