LA PINE RODEO

LA PINE RODEO
June 21st Playday Buckle Series Form
TODAYS DATE

MonthDayYear
Date
First Name
Last Name
Phone Number
Horses Names
Emergency Contact
Phone
If Competitor is under the age of 18:
Competitor Age
ParentGuardian
Phone
AGE DIVISION
[] Pewee (6 & under) [] Senior (14-17)

Intermediate (10-13) [] Super Senior (50 & up)

Address: PO Box 674, La Pine, OR 97739 Email: info@lapinerodeo.com Website: www.lapinerodeo.com
LA PINE RODEO
Total
Please make checks payable to:

I am signing this Entry Form freely and voluntarily on behalf of myself and/or my minor child(ren
Participant Name
Participant Signature

Clear
ParentGuardian Name
ParentGuardian Signature

Clear
Address: PO Box 674, La Pine, OR 97739 Email: info@lapinerodeo.com Website: www.lapinerodeo.com
Age Division

Pewee(6 & under)Junior(7-9)Intermediate(10-13)Senior(14-17)Adult(18-49)Super Senior(50 & up)
Events($5 per Event)

Barrel RacingPolesKeyholeFigure 8

My Products

Barrel Racing

$5.00 Quantity

Poles

$5.00 Quantity

Keyhole

$5.00 Quantity

Figure 8

$5.00 Quantity

Total

$0.00