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Rodeo Bible Camp Registration 2008 FELLOWSHIP OF CHRISTIAN COWBOYS, INC. 4442 Penwell Bridge Road Belgrade. MT 59714 406-388-4807 FAX 406-587- 5152 RODEO BIBLE CAMP Name______________________________________________________________ First Middle Initial Last Phone__________________________ Address____________________________________________________________ _______________________ City____________________________ State__________ Zip______________________________ In case of emergency contact (relative or friend)___________________________ Phone_________________________________ Birth Date ___________/____________/______________ Male Female Month Day Year Have you participated in a rodeo before as a contestant?_______________ If yes, years _______________. If no, will this be your first time in rough stock or timed events?____ Have you every been to a rodeo camp before?___________________ Do you have or have you had any injuries in the last 6 months?___________ If yes, please explain___________________________________________ Are you taking any medication prescribed by a physician?______________ Yes please explain______________________________________________ Camp is limited to instruction in one (1) event. Events are limited to ten (10) students. EVENT DECLARATION (Place a "1" by your first choice, a "2" by your second choice, and a"3' by your third choice.*
Heading_________ Pole Bending_________ Barrel Racing__________ Heeling____________ Goat Tying____________ Steer/Bull riding_______________ Breakaway Roping_________Clowning_____________
*Participants will only be able in compete for a buckle in one declared event ALL PARTICIPANTS MUST SHOW PROOF OF INSURANCE |
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(PARENT OR LEGAL GUARDIAN MUST SIGN IF PARTICIPANT IS A MINOR UNDER THE LAW OF THE STATE OF RESIDENCE AND/ OR A STUDENT. THE I IN THE FOLLOW WILL REFER TO THE CAMPER AND HIS OR HERS FAMILY) RELEASE AND AGREEMENT NOT TO SUE IN CONSIDERATION OF BEING ALLOWED TO RIDE AND PARTICAPATE IN FELLOWSHIP OF CHRISTIAN COWBOYS RODEO BIBLE CAMP. I AND MY HEIRS, SUCCESSORS, PERSONAL REPRESENTATIVES AND NEXT OF KIN, HEREBY RELEASE, WAIVE, DISCHARGE AND AGREE TO HOLD HARMLESS AND INDEMNIFY ALL PERSONS INVOLVED WITH THE FCC GALLATIN CHAPTER R.B.C OPERATIONS OR INSTRUCTORS, THEIR AGENTS, REPRESENTATIVES, (COLLECTIVELY) FROM ALL LIABILITY TO ME AND MY PERSONAL REPRESENTATIVES, HEIRS, SUCCESSORS, AND NEXT OF KIN FROM ALL CLAIMS AND LIABILITY FOR ALL LOSS OF DAMAGE, AND ANY CLAIM OF DAMAGES THEREFORE ON ACCOUNT OF ANY INJURY TO MY PERSON INCLUDING DEATH OR DAMAGE TO MY PROPERTY WHILE I AM UTILIZING THE FACILITIE OR PARTICIPATING IN ANY EVENTS. DATED THIS __ day of _______ 2003 PARTICIPANTS________________________________________
(PARENT OR LEGAL GUARDIAN MUST SIGN IF PARTICIPANT IS A MINOR UNDER THE LAW OF THE STATE OF SIGNATURE_____________________________________ SIGNATURE_____________________________________ STATE OF______________________________________ DATE________________ DATE________________ COUNTY OF_____________ ON THIS________ DAY OF__________, 2002, BEFORE ME THE UNDERSIGNED, A NOTARY PUBLIC IN AND FOR THE STATE OF MONTANA, PERSONALLY APPEARED___________________________________________ |
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PARENTAL RELEASE (FOR REGISTRATION) I/We,. the undersigned, certify that I/we am/are the parent(s) or lawful guardian(s) of a minor. I understand that the above named minor will be participating in rodeo events with live rodeo animals. I consent to this child's participation and accept the risk that an injury can occur. I consent in such case to emergency treatment rendered at the discretion of qualified medical personnel. In the event of an injury, I agree to make claim against my health carrier first and FCC's carrier second. I understand that FCC's insurance has a maxim limitation of $500,000.00 per injury, and I agree to hold FCC harmless for any uninsured medical expenses incurred by my/our child, and I further agree to indemnify the corporation and its employees, agents and assignees from any loss whether temporary or permanent. I understand that I am releasing FCC and its employees, agents and assignees from any and all liability for injury to the child named in this release. The consideration for this release is the training for rodeo events without cost. I understand that registration fees go for food, facilities and rodeo livestock; and there is no fee for instruction in rodeo events. Signature of Parent or Guardian
Signature of Parent or Guardian Both parents must sign. if living. If divorced, parent having legal custody must sign as legal guardian. NOTARY SIGNATURE AND SEAL. Signature Date |
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RODEO BIBLE CAMP HEALTH FORM (ONE CAMPER PER FORM) Camper's Name:______________________________________________ Parents' Names:_______________________________________________ Date of Birth:_________________________________________________ Home Phone:__________________________________________________ Address:_____________________________________________________ City:________________________________________________________ State:_______________________________________________________ Zip:__________________________________________________________ Father's Employer:_________________________________________Phone:________-_________ Mother's Employer:________________________________________________ Phone:________-_________ Additional Phone #s - in case you can't be reached: 1)________________ 2)________________ 3)________________ Your Doctor's Name:________________________________________________ Phone:________-________ Name of your Hospitalization. Insurance Company:____________________________ Group or Policy #:_____________________________________________________ MEDICAL INFORMATION OF CAMPER Please list any medications that your child will bring to camp: (Include non-prescription intents such as aspirin. vitamins. etc., as well as prescription Medications) Reasons for taking:_____________________________________________________ Does your child have seizures: YES / NO Most recent occurrence:__________________________________________________ Has your child ever been knocked unconscious or passed out? YES / NO Yes, when and how?_____________________________________________________ The date your child last saw a physician:_____________________________________ Reason for the visit:____________________________________________________ Year of last Tetanus shot:_________________________________________________ Circle any Allergies: Hay Fever Poison Ivy Insect sting Penicillin Asthma Other Does your child have a history of: Heart Problems YES / NO Diabetes YES / NO List any other helpful medical information that will assist in the management of your child ______________________________________________________ _______________________________________________________________ This health form release must be signed by parent or legal guardian and sent with camp registration. This health history is correct as far as I know. In case I cannot be reached, I hear by give permission to medical personnel with proper credentials to give emergency treatment to: CampersName:_________________________________________________________ Soc:________________________ Signed:____________________________________________ Date:______-_______-______
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