Wyoming Junior Rodeo Association

Date ______

Ck #_____$______

Office Use ONLY

WYOMING JUNIOR RODEO ASSOCIATION

MEMBERSHIP APPLICATION 2017-2018

(Please Print or Type)

Name:______

Mailing Address:______Telephone: (______) ______

City, State/Province: ______Zip+4 / Postal Code:______

Email Address:______

Date of Birth: Month______Day______Year______(circle one): Male Female Current Grade in School ____

Age as of September 1, 2017______Division _____PeeWee _____ Junior _____Senior

Were you previously a member of the WJRA ? Check one: ______(1st year) ______Renewing Member

Dues and Fees: Competing Associate

WJRA Dues ………(Circle one) If applying for family please attach additional membership for each member.

Before 3/31/2018: Single $25Family $40After 3/31/18Single $40Family $65

Fundraiser …. Please send a separate check for $140 per member for calendar fundraiser. Calendar checks will be deposited immediately and will not be refunded. Parents initials______

(As a competing member you are eligible to enter any of the events offered for yourage & gender. For statistical purposes, please check any and all of the events you are planningto enter at any time this rodeo season.)

PEEWEE EVENTSJUNIOR & SENIOR JUNIOR & SENIOR

EVENTSBOY’S EVENTSGIRL’S EVENTS

_____ Barrel Racing_____ Steer Riding_____ Barrel Racing

_____ Pole Bending_____ Goat Tying_____ Pole Bending

_____ Goat Tail Tying_____ Breakaway (boys only)_____ Goat Tying

_____ Team Roping_____ Breakaway (girls only) _____ Calf Tying Senior Boys ONLY _____ Team Roping

Jacket Size ______CK # ______

Signature Member Date *Jacket sizes: YS, YM, YL & AS, AM, AL, AXL, AXXL

See attached sheet for more members

READ AND SIGN BELOW:NOTE: Signature of children indicates that they are a voluntary participant in accordance with Wyoming Statute 1-1-118.***Copy of birth certificate must be on file with WJRA***

Indemnification and Release: READ CAREFULLY THIS WAIVER OF YOUR RIGHTS.

I acknowledge that participation in a WJRA activity as a competitor, volunteer, or spectator exposes the participant to substantial and serious risks of property damage, personal injury, or death. I assume all risks to myself, my guests, and my children including risks which can be eliminated, altered or controlled whether or not integral to equestrian recreational activities in consideration for by children being permitted to participate in WJRA activities. I hereby indemnify, hold harmless, and release WJRA executive committee, sponsors, volunteers, land owners, stock producers, and any WJRA production entity or organization from liability for any and all property damage, personal injuries, or other claims arising from my child’s, my own, or my guests’ participation in any WJRA activity, including, but not limited to, rodeos, practices, or play days, including claims that are known and unknown, foreseen or unforeseen, future or contingent.

I affirm or swear that I am the legal guardian or parent of the above named child(ren), that all of the information provided above is correct, I hereby give this, my written consent, for said child(ren) to participate in any WJRA activity, that in the event of the signature of only one parent I have authority to bind both parents with my signature, that I have read and understand the indemnification and release written above and hereby indemnify, hold harmless, and release the individuals and entities listed therein.

Signature FatherDateSignature MotherDate

Print Fathers Name:______Print Mothers Name:______

Notary Public:

Date County

Subscribed and sworn to me by the above named parent(s) and/or guardian(s).

Make checks payable to: Wyoming Junior Rodeo Association, Inc.

Mail membership to: Stephanie Bentley 8189 W Zero Road Casper, WY 82604

(Please Print or Type)

Name:______

Gender (circle one): Male Female

Date of Birth: Month______Day______Year______Current Grade in School ______

Age as of September 1, 2017______Division _____PeeWee _____ Junior _____Senior

Were you previously a member of the WJRA ? Check one: ______(1st year) ______Renewing Member

As a competing member you are eligible to enter any of the events offered for your age & gender. For statistical purposes, please check any and all of the events you are planning to enter at any time this rodeo season.

PEEWEE EVENTSJUNIOR & SENIOR JUNIOR & SENIOR

EVENTSBOY’S EVENTSGIRL’S EVENTS

_____ Barrel Racing_____ Steer Riding _____ Barrel Racing

_____ Pole Bending_____ Goat Tying_____ Pole Bending

_____ Goat Tail Tying_____ Breakaway_____ Goat Tying

_____ Team Roping_____ Breakaway _____ Calf Tying Senior Boys ONLY _____ Team Roping

Signature MemberDateJacket Size ______

(Please Print or Type)

Name:______

Gender (circle one): Male Female

Date of Birth: Month______Day______Year______Current Grade in School ______

Age as of September 1, 2017 ______Division _____PeeWee _____ Junior _____Senior

Were you previously a member of the WJRA ? Check one: ______(1st year) ______Renewing Member

As a competing member you are eligible to enter any of the events offered for your age & gender. For statistical purposes, please check any and all of the events you are planning to enter at any time this rodeo season.)

PEEWEE EVENTSJUNIOR & SENIOR JUNIOR & SENIOR

EVENTSBOY’S EVENTSGIRL’S EVENTS

_____ Barrel Racing_____ Steer Riding _____ Barrel Racing

_____ Pole Bending_____ Goat Tying_____ Pole Bending

_____ Goat Tail Tying_____ Breakaway_____ Goat Tying

_____ Team Roping_____ Breakaway _____ Calf Tying Senior Boys ONLY _____ Team Roping

Signature MemberDateJacket Size ______

(Please Print or Type)

Name:______

Gender (circle one): Male Female

Date of Birth: Month______Day______Year______Current Grade in School ______

Age as of September 1, 2017______Division _____PeeWee _____ Junior _____Senior

Were you previously a member of the WJRA ? Check one: ______(1st year) ______Renewing Member

As a competing member you are eligible to enter any of the events offered for your age & gender. For statistical purposes, please check any and all of the events you are planning to enter at any time this rodeo season.)

PEEWEE EVENTSJUNIOR & SENIOR JUNIOR & SENIOR

EVENTSBOY’S EVENTSGIRL’S EVENTS

_____ Barrel Racing_____ Steer Riding _____ Barrel Racing

_____ Pole Bending_____ Goat Tying_____ Pole Bending

_____ Goat Tail Tying_____ Breakaway_____ Goat Tying

_____ Team Roping_____ Breakaway _____ Calf Tying Senior Boys ONLY _____ Team Roping

Signature MemberDateJacket Size ______

Wyoming Junior Rodeo Association, Inc.

Mail membership to: Stephanie Bentley 8189 W Zero Road Casper, WY 82604