~ ~"Special Needs Entry Forms"~ ~




Rodeo Entry Form

logoSpecial Needs Rodeo Entry Form

Please fill out and return this form by August 3, 2017, to:

Candyce Meriwether
519 South 1070 East
Heber, Utah 84032


I would like my child to be considered as a participant in the Mountain Valley Stampede Rodeo on Friday, August 3, 2018 at 10 am (check-in at 9:30 am). Participants in the Princess Contest will need to check in at 8:30 am. Princess Contest begins at 9 am. Rodeo limited to first 100 participants.

PLEASE PRINT CLEARLY:

Child’s Name:______________________________ Child’s Age:_____

Physical Limitations:__________________________ Height:_______Weight:_______

Parent/Guardian Name:_________________________________________________________

Mailing Address:_________________________________City:____________State:____Zip:______

Work Phone:_________________Home Phone:________________Cell Phone:________________

Parent/Guardian Signature_______________________________________________________

If you would like your child to participate and be acknowledged in the Mountain Valley Stampede Rodeo on Friday, August 3 at 7:00 pm, you can purchase discounted rodeo tickets. Discounted family pass for 4 is $30.00. Each additional ticket will be $8.00 each. Your participant in the Special Needs Rodeo will not have to purchase a ticket. Please indicate how many tickets you would like to purchase and include a check or money order with entry form. Make checks payable to Mountain Valley Stampede Rodeo

Mountain Valley Stampede evening PRCA Rodeo Tickets#______Family pass @$30.00 ______#@ $8.00 = $_____

Enter your e-mail address _____________________________________

LIABILITY WAIVER & RELEASE In consideration of my child's participation in the above event, I, the undersigned parent/guardian agree and acknowledge that there are hazards associated with my child's participation in this activity, including but not limited to physical injury or death. I fully assume all risks associated with my child's participation in this activity. I hereby waive, release, and discharge for myself, my family members, heirs, administrators and assigns any and all rights and claims which may accrue to me or my child, against Wasatch County, its officers, employees, volunteers and agents (hereinafter the County). Further, I will indemnify and hold the County harmless from all liability, and provide for the defense of the County, in the event that the County is sued as a result of my child's participation. If my child is injured and requires medical care, I consent to such care. I hereby certify that I have read and understand the foregoing legal document and sign it knowingly, willingly, and voluntarily.

Parent/Guardian Signature_________________________________________________

Date_________________________________________________



Princess Entry Form

logoSpecial Needs Rodeo Princess Entry Form

Please fill out and return this form by August 1, 2016, to:

Candyce Meriwether
519 South 1070 East
Heber, Utah 84032


I would like my child to be a participant in the Mountain Valley Stampede Rodeo Princess Contest on Friday, August 3, 2018. Participants in the Princess Contest will need to check in at 8:30 am. Princess Contest begins at 9 am.

PLEASE PRINT CLEARLY:

Child’s Name:______________________________ Child’s Age:_____

Physical Limitations:__________________________

Interests/Talents_____________________________________________________________

Parent/Guardian Name:_________________________________________________________

Mailing Address:_________________________________City:____________State:____Zip:______

Work Phone:_________________Home Phone:________________Cell Phone:________________

Parent/Guardian Signature_______________________________________________________

Contestants should be dressed in their western wear or best dress.They will be introduced and answer one question from our judges.

If you would like your child to participate and be acknlowleged in the Mountain Valley Stampede Rodeo on Friday, August 3, at 7:00 pm, you can purchase discounted rodeo tickets. Discounted family pass for 4 is $30.00. Each additional ticket will be $8.00 each. Your participant in the Special Needs Rodeo will not have to purchase a ticket. Please indicate how many tickets you would like to purchase and include a check or money order with entry form. Make checks payable to Mountain Valley Stampede Rodeo

Mountain Valley Stampede evening PRCA Rodeo Tickets#______Family pass @$30.00 ______#@ $8.00 = $_____

Enter your e-mail address _____________________________________

LIABILITY WAIVER & RELEASE In consideration of my child's participation in the above event, I, the undersigned parent/guardian agree and acknowledge that there are hazards associated with my child's participation in this activity, including but not limited to physical injury or death. I fully assume all risks associated with my child's participation in this activity. I hereby waive, release, and discharge for myself, my family members, heirs, administrators and assigns any and all rights and claims which may accrue to me or my child, against Wasatch County, its officers, employees, volunteers and agents (hereinafter the County). Further, I will indemnify and hold the County harmless from all liability, and provide for the defense of the County, in the event that the County is sued as a result of my child's participation. If my child is injured and requires medical care, I consent to such care. I hereby certify that I have read and understand the foregoing legal document and sign it knowingly, willingly, and voluntarily.

Parent/Guardian Signature_________________________________________________

Date_________________________________________________

Carnival Form

logoCarnival Ticket Form

All Carnival Tickets must be purchased on or before July 15, 2018

Please fill out and return this form with your money as soon as possible as tickets run out quickly. Send to:

Candyce Meriwether
519 South 1070 East
Heber, Utah 84032


PLEASE PRINT CLEARLY:

Name:__________________________________________

Mailing Address:_________________________________City:____________State:____Zip:______

Number of tickets____________@$18.00 each=_________________________________

Make checks payable to: Mountain Valley Stampede