confirm _________ pd _________ SS
_________
La Veta Rodeo Bible Camp Registration Form
June 20____
Please PRINT the following information:
Name
_____________________________ Age____ Birthdate ___/___/____
Address _______________________________________________Sex_____
City ___________________________________State____ Zip ___________
E-mail ( to send confirmation
to)___________________________
FAX _________
Parent's Names_________________________________________________
Parent's work phone_____________________,
_______________________
Other contact phone #'s
_______________________,___________________
What is your experience?
Beginner
Intermediate
Advanced (Circle One)
EVENTS
Please choose your event
with the number (1). Also number your second (2) and third (3)
choices as each event is limited
COWBOYS
|
COWBOYS &
COWGIRLS
|
COWGIRLS
|
( ) Saddle
Bronc
|
( ) Shooting Sports
|
( ) Barrel Racing
|
( ) Bareback Riding
|
( )
Horsemanship
|
( ) Pole Bending
|
( ) Bull Riding
|
( ) Team
Roping
|
( ) Goat
Tying
|
( ) Steer
Wrestling
|
( ) Trick
Riding
|
( ) Breakaway
|
( ) Calf
Roping
|
|
|
MUST BE RECEIVED BY JUNE 1
COMPLETE REGISTRATION
FORM, HEALTH CARD, PROOF OF INSURANCE & RELEASE FORM AND MAIL WITH
YOUR FEES OF $150.00
TO: MICKEY SCHMIDT, P.O. BOX 373, LAVETA, CO. 81055
CONTACT US: 719-742-3300 or e-mail -
malea15@centurytel.net , lavetamick@centurytel.net