Elks Team Roping Entry Form and General Waiver Form

Santa Maria Elks Team Roping Entry
Entries must be completed and received along with entry fee by
5:00 PM on Friday - May 1st, 2015
May 28th – May 31st, 2015
Entry Fee - $150.00 per Team
Two & Short
(Top 5 to return for finals on Sunday - May 31st)
$1000 Added
AWARDS TO WINNERS OF THE AVERAGE
Entries are limited to the following:
1. Two (2) Ropers Team – ONLY
2.
3.
4.
5.
6.
7.
Two Elk Members
Elk Member and Wife
Elk Member and Child or Grandchild (18 years or younger)
Any Elk heeler, 55 or older, can tie on
Go once
1/3 out to cattle charges
All Elk members must hold current membership card to one of the West Central Coast Elks Lodges. You will
be required to show valid medical insurance card at time of entry. PRCA and Elks Team Ropers may only
compete in one of the team roping events – NOT BOTH, unless they are a PRCA Gold Card Holder.
The Elks Team Roping Draw will be completed prior to our event and the draw will be available by visiting
our website at www.elksrec.com on the Team Roping page. Your Contestant Packet will be available for
pickup at the Elks Rodeo Office between May 18th and May 22nd, after that date they will be available at
the Contestant Booth located at Gate #2 when you arrive at the Elks Unocal Event Center.
Header Name: ___________________________________________________________________________
Email: ___________________________________
Phone: _______________________
Address: _______________________________________________________________________________
(Street or P.O. Box)
Elks Membership #:____________________
(City)
(State)
(Zip)
Lodge Name: ___________________________________
Healer Name: ___________________________________________________________________________
Email: ____________________________________
Phone: _______________________
Address: _______________________________________________________________________________
(Street or P.O. Box)
Elks Membership #:____________________
(City)
(State)
(Zip)
Lodge Name: ____________________________________
Page 1 of 5
Teamroping: Team Roping 2015: Elks Team Roping Entry 2015
2015 Elks Recreation, Inc.
Release of Claims, Waiver and Hold Harmless Agreement
Elks Team Roping
Contestant#
_______________________________________________
Contestant Name
Phone
Address
___________________
Date of Birth
E-Mail
City
State
Zip
NAMES OF PARENTS, CUSTODIANS OR LEGAL GUARDIANS (If under 18 years of age)
__________________________________________
Father’s Name
Address
City
______________________
Phone Number
State
__________________________________________
Mother’s Name
Address
City
Zip
______________________
Phone Number
State
Zip
ALL ENTRANTS & ENTRANT’S LEGAL GUARDIANS MUST COMPLETE ALL RELEASE,
WAIVER AND HOLD HARMLESS AGREEMENTS AND IT MUST BE SIGNED BY BOTH OF THE
MINOR’S PARENTS, CUSTODIANS OR LEGAL GUARDIANS IF CONTESTANT/CARRIER IS
UNDER THE AGE OF 18. IF THERE IS ONLY ONE PARENT, CUSTODIAN OR LEGAL
GUARDIAN, THAT PERSON WILL ASSUME ALL LIABILITY AND RESPONSIBILITIES.
The undersigned for ourselves and on behalf of participant voluntarily assume any and all risks
arising out of and/or connected with his or her participation in the above named event and release
Santa Maria Elks Lodge #1538 and Elks Recreation, Inc., it’s employees, agents, and/or officers
and sponsors, their spouses, executors, and/or administrators of their estates, and any and all other
persons and associates or officers of the above named from all claims, injuries, losses, damages,
attorney fees and causes of actions that may result from his or her participation in all Elks
Recreation, Inc. Events.
(Continued)
Page 2 of 5
Teamroping: Team Roping 2015: Elks Team Roping Entry 2015
For ourselves and for participant we waive the provisions of California Civil Code section 1542
which reads:
A general release does not extend to claims which the creditor does not
know or suspect to exist in his or her favor at the time of executing the release
which if known by him or her must have materially affected his or her
settlement with the debtor.
The undersigned understands the significance of this waiver of California Civil Code section 1542
as if I, my child, my horse, and/or my property is injured, damaged, or becomes ill, I, my child and
my legal representatives, heirs, assigns and estate cannot make claims for those damages, injuries
and illnesses.
By signing this release, I grant the Elks Recreation, Inc. and Santa Maria Elks Lodge #1538 and the
operators of its activities and events, their employees, agents, and assigns my permission to initiate
emergency first aid treatment for myself or my child in the event such treatment is reasonably
required, which determination may be made at their discretion.
I agree and understand this agreement is intended to be as broad and inclusive as permitted by the
laws of the State of California, and if any portion of this agreement is invalid, it is agreed the
remainder of this agreement shall continue in full force and effect.
I have carefully read this Agreement, fully understand its contents, and agree to each statement set
forth herein. I am aware that this is a release of liability and a contract to hold harmless the Santa
Maria Elks Lodge #1538 and Elks Recreation, Inc. and all representatives representing these
organizations, from all liability, losses and damages to participant.
Signed this
day of
, 2015 in Santa Maria.
SIGNATURE OF CONTESTANT AND LEGAL CUSTODIANS OR LEGAL GUARDIANS
X
__
Print Name/Title
Signature
Date
Signature
__
Date
X
Print Name/Title
_______________________________
WITNESS
_______________
DATE
******************** DO NOT WRITE BELOW THIS LINE******************
______ Verification of Age
______ Verification of Insurance
Page 3 of 5
Teamroping: Team Roping 2015: Elks Team Roping Entry 2015
2015 Elks Recreation, Inc.
Release of Claims, Waiver and Hold Harmless Agreement
Elks Team Roping
Contestant#
_______________________________________________
Contestant Name
Phone
Address
___________________
Date of Birth
E-Mail
City
State
Zip
NAMES OF PARENTS, CUSTODIANS OR LEGAL GUARDIANS (If under 18 years of age)
__________________________________________
Father’s Name
Address
City
______________________
Phone Number
State
__________________________________________
Mother’s Name
Address
City
Zip
______________________
Phone Number
State
Zip
ALL ENTRANTS & ENTRANT’S LEGAL GUARDIANS MUST COMPLETE ALL RELEASE,
WAIVER AND HOLD HARMLESS AGREEMENTS AND IT MUST BE SIGNED BY BOTH OF THE
MINOR’S PARENTS, CUSTODIANS OR LEGAL GUARDIANS IF CONTESTANT/CARRIER IS
UNDER THE AGE OF 18. IF THERE IS ONLY ONE PARENT, CUSTODIAN OR LEGAL
GUARDIAN, THAT PERSON WILL ASSUME ALL LIABILITY AND RESPONSIBILITIES.
The undersigned for ourselves and on behalf of participant voluntarily assume any and all risks
arising out of and/or connected with his or her participation in the above named event and release
Santa Maria Elks Lodge #1538 and Elks Recreation, Inc., its employees, agents, and/or officers and
sponsors, their spouses, executors, and/or administrators of their estates, and any and all other
persons and associates or officers of the above named from all claims, injuries, losses, damages,
attorney fees and causes of actions that may result from his or her participation in all Elks
Recreation, Inc. Events.
(Continued)
Page 4 of 5
Teamroping: Team Roping 2015: Elks Team Roping Entry 2015
For ourselves and for participant we waive the provisions of California Civil Code section 1542
which reads:
A general release does not extend to claims which the creditor does not
know or suspect to exist in his or her favor at the time of executing the
release which if known by him or her must have materially affected his or her
settlement with the debtor.
The undersigned understands the significance of this waiver of California Civil Code section
1542 as if I, my child, my horse, and/or my property is injured, damaged, or becomes ill, I, my child
and my legal representatives, heirs, assigns and estate cannot make claims for those damages,
injuries and illnesses.
By signing this release, I grant the Elks Recreation, Inc. and Santa Maria Elks Lodge #1538 and
the operators of its activities and events, their employees, agents, and assigns my permission to
initiate emergency first aid treatment for myself or my child in the event such treatment is
reasonably required, which determination may be made at their discretion.
I agree and understand this agreement is intended to be as broad and inclusive as permitted by
the laws of the State of California, and if any portion of this agreement is invalid, it is agreed the
remainder of this agreement shall continue in full force and effect.
I have carefully read this Agreement, fully understand its contents, and agree to each statement
set forth herein. I am aware that this is a release of liability and a contract to hold harmless the
Santa Maria Elks Lodge #1538 and Elks Recreation, Inc. and all representatives representing
these organizations, from all liability, losses and damages to participant.
Signed this
day of
, 2015 in Santa Maria.
SIGNATURE OF CONTESTANT AND LEGAL CUSTODIANS OR LEGAL GUARDIANS
X
Print Name/Title
Signature
___
Date
Signature
___
Date
X
Print Name/Title
_______________________________
WITNESS
_______________
DATE
******************** DO NOT WRITE BELOW THIS LINE******************
______ Verification of Age
______ Verification of Insurance
Page 5 of 5
Teamroping: Team Roping 2015: Elks Team Roping Entry 2015