Standard Entry Blank for Non-Members

The Standard Entry Blank is provided to facilitate entry into any approved Little Britches Rodeo. It is YOUR RESPONSIBILITY to know the particulars of each rodeo including, but not limited to fees, deadline, limited entry, etc. This information is available via the web at www.nlbra.com and in the NLBRA pages of the RODEO NEWS. In using the Standard Entry Blank, it is understood that neither the National Office nor the rodeo shall become responsible for errors in submitting entry!

Important!

Parents (or Guardian) Must Complete This Medical Information and Sign Consent.

Contestant Name

First Name

Last Name

Birth Date

MM

DD

YYYY

Today's Date

MM

DD

YYYY

Does contestant have serious illness?

Please include malformations and injuries.

Does contestant have drug allergies?

Explain.

Date of tetanus immunization or booster shot:

MM

DD

YYYY

Has contestant suffered prior rodeo injuries?

Include date and rodeo.

Other remarks:

It is mutually understood that said contestant is protected under provisions of a limited medical insurance policy, as set forth ni the rules, in which we, the parents or guardians, agree to pay the deductible and co-insurance portion of any claim. We, the parents and/or guardians, and contestant, HAVING READ THE L B R A RULE BOOK AND COMPLETED the ENTRY, herewith give consent for participation of the contestant whose name appears on the reverse side, and the approved Little Britches Rodeo at the location and on those dates noted on the reverse side. We acknowledge that participation in any National Little Britches Rodeo Association, (hereinafter NLBRA) sanctioned rodeo or activity as a competitor, participant, volunteer or spectator exposes a competitor, participant, volunteer or spectator to a substantial and serious risk of property damage, personal injury, or death. We assume al risks to ourselves, our guests and our children, including risk which can be eliminated, altered or controlled, whether or not integral to equestrian recreational activities. In consideration for our child being permitted to participate in NLBRA rodeos and activities, we hereby agree to indemnify, hold harmless and release NLBRA its agents, executive committee members, sponsors, volunteers, owners, stock contractors and any NLBRA franchisee. production entity or organization. their agents. representatives. sponsors. volunteers. owners. and stock contractors from liability for any and all property damage, personal injuries, death, or other claims arising from our child(s), our own, or our guest(s) participation in any NLBRA activity, including but not limited to, rodeos, practices, play days, or other activities, including claims that are known or unknown, foreseen or unforeseen, future or contingent. This release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by law, if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. Also, ti is mutually understood that the Rodeo Sponsors shall retain al rights and privileges of said rodeo. nI submitting entry, contestant, parents and/or guardians agree to permit use of al publicity, photographs, radio and televisions broadcasts, motion pictures, newspaper and magazine accounts and websites. NOTE TO PARENTS: In case of injury it becomes the responsibility of the parent, guardian, or injured contestant to secure insurance claim forms from the Rodeo Secretary where injury occurred. Rodeo Secretary MUST sign the claim form. Contestants portion of the form MUST be completed. Then mail direct, along with invoice of services and copy of any Explanation of Benefits from other (primary) insurance, to the insurance claims office for payment. The deductible and co-insurance is paid by parents, guardian, or contestant directly to attending physician or hospital.

Acknowledged