Chambers County Youth Project Show Small Animal Scramble Application

Chambers County Youth Project Show
Small Animal Scramble Application
This form must be hand-delivered to the CCYPS Office.
Exhibitor’s Name _____________________________________________________ Age ___________
Male 
Female 
Parent’s Name ________________________________________________ Exhibitor’s Birthdate ____ / _____ / _________
Mailing Address _________________________________________________ T-Shirt Size (Adult) (Circle one.) S M L XL
City _____________________________________________ State __________ Zip Code _____________ Phone ______________________
Email Address ________________________________________________________________________________________________________
 Junior (9 to 13-years-old)
School:  Anahuac
 Senior (14-years-old or over) (Age determined as of show date.)
 Barbers Hill
Grade ____________  High
 East Chambers
 Middle/Junior
 Intermediate
 Other ______________________________________________
 Elementary
 Primary  Kindergarten
 4-H  FFA  IND Club/Chapter ______________________ Number of Years in Club/Chapter ______________________
Have you ever participated in a calf scramble?  Yes
 No
If so, when and where _______________________________________________________________________________________________________
Please describe the facilities you have or could provide to care for an animal _________________________________________
_________________________________________________________________________________________________________________________________
On an additional sheet of paper please describe why you would like to participate in the scramble and catch a
calf to feed out for next year’s CCYPS.
Small Animal Scramble Agreement
I am a contestant in the Chambers County Small Animal Scramble, where animals are sponsored by business firms and individual citizens.
Should I catch an animal, I agree to provide the necessary equipment and facilities for the animal to feed and to feed and care for the animal as
directed by my County Extension Agent, 4-H Adult Leader or Agricultural Science Teacher and the Chambers County Youth Project Show Livestock
Committee.
I further understand that if I catch an animal, I will be awarded a goat, lamb or pig donated by a sponsor or a check not to exceed $100. Should I
receive the $100 sponsorship, I will have the opportunity to purchase an animal which could be a goat, lamb or pig. However, I understand that the
scramble animal must be a market animal.
All goats, lambs and pigs must be tagged in at the Annual Chambers County Youth Project Show Small Animal Validation event.
Moreover, I agree to exhibit my animal at the following year’s Chambers County Youth Project Show and provide my sponsor, the livestock
committee, the County Extension Agent and my ag teacher/4-H adult leader with monthly reports on the status of my project.
I agree to return whatever money I received to the Chambers County Youth Project Show Livestock Committee within 60 days of receiving my
animal/check without reimbursement if in the opinion of the Committee I am not fulfilling my obligations. I also agree that if I neglect my animal at
any time before the Chambers County Youth Project Show or do not follow my County Extension Agent, 4-H Adult Leader’s or Agricultural Science
Teacher’s instructions the Scramble Committee has the authority to require me to return all monies received by the committee to help purchase my
calf.
I have read and do agree to abide by all the above rules and regulations as well as those laid out in previous pages.
Exhibitor Signature __________________________________________________________________ Date _________________________
2015 CCYPS 1
Chambers County Youth Project Show
Small Animal Scramble Minor’s Release
THE STATE OF TEXAS
COUNTY OF CHAMBERS
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I, or we, ______________________________________________________ (father) and _____________________________________________________ (mother), the
undersigned, are the legal guardians of _____________________________________________________ (child) a minor, being ______________ years of
age do hereby consent to allow our child to participate in “The Chambers County Small Animal Scramble” during the Chambers
County Youth Project Show on Saturday. We hereby release all sponsors, cooperating agencies, organizations, committees, and
individuals and other participants while actually engaged in scramble activities, from all claims for liability for bodily injury
and/or property damage which may be sustained by our minor child while he/she is engaged as a participant in the calf scramble.
The undersigned affirmatively state and represents that the minor herein above named is not under the age of 9 years, and was
born on the ________________ day of _________________________________________, __________________.
WITNESS OUR HANDS, THIS THE ________________ day of _______________________________________, _________________.
FATHER/GUARDIAN SIGNATURE __________________________________________________________________________________
MOTHER/GUARDIAN SIGNATURE _________________________________________________________________________________
MINOR CHILD SIGNATURE _________________________________________________________________________________________
THE STATE OF TEXAS
COUNTY OF CHAMBERS
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BEFORE ME, the undersigned authority, a notary public in and for ______________________________________ County, Texas, personally
appeared _____________________________________________________ (father) and _____________________________________________________ (mother)
who declared upon oath, after being duly sworn, that they executed the attached scramble instruments for the purposes and
consideration therein expressed and that they and each of them, read the instruments, and fully understand them. I certify that
these instruments were executed in my presence on this the ______________ day of ______________________________________, ________________.
And that the persons who signatures are affixed thereto are personally known to me to be the persons signing the same
represented in such instruments.
WITNESS MY HAND AND SEAL OF OFFICE, THIS THE _____________ DAY OF ______________________________________________, ________________.
_______________________________________________________________________
Notary Public in and for _________________________ County, Texas.
2015 CCYPS 2