LA PINE

LA PINE
RODEO
September 20th 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
Type a question

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

($5 per event)
Type a question

Barrel RacingSpeed BarrelsPolesBirangle
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

My Products

Barrel Racing

$5.00 Quantity

Speed Barrels

$5.00 Quantity

Poles

$5.00 Quantity

Birangle

$5.00 Quantity

Total

$0.00

Address: PO Box 674, La Pine, OR 97739 Email: info@lapinerodeo.com Website: www.lapinerodeo.com
Should be Empty: