Dixie Round Up Barrel Race Entry Form

Barrel Race Entry Form

October Barrel Bash
Rider Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Attention Youth riders make sure to mark both boxes if you will be rolling your time over from the open to youth!
Horse Name
Select class or classes

Kiddie 10$ (no processing fee)open 50$youth 30$processing fee 10$ (per person)Roll open to youth
Horse Name
Select class or classes

Kiddie 10$ (no processing fee)open 50$youth 30$processing fee 10$ (per person)Roll open to youth
Horse Name
Select class or classes

Kiddie 10$ (no processing fee)open 50$youth 30$processing fee 10$ (per person)Roll open to youth
Total owed
RELEASE & AGREEMENT: Under Mississippi law, an equine or livestock activity sponsor or an equine or livestock professional is not liable for an injury to or the death of a participant in equine activities or livestock shows resulting from the inherent risks of equine activities or livestock shows, pursuant to this chapter TITLE 93. I RELEASE the event organizer Tiffany Kennedy Leckich and property owner Laurie Kennedy at 2710 hwy 15 Wiggins MS from all legal responsibility from participation in the October Barrel Bash on October 25th 2025. The participant fully understands that this event is clearly ride at your own risk and the participant agrees the event organizer and property owner will not be held responsible for any claims or losses from participation in the October Barrel Bash 4D barrel run on October 25,2025
Signature date*

MonthDayYear
Date
Signature of Participant or Legal Guardian

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