Gymkhana Entry Form

You can go here to download a copy of the entry form Family Gymkhana 

Montezuma County Fair Family Gymkhana
Saturday July 28th 10:00 am at the Montezuma County Fairgrounds Outdoor arena
Must reside in Montezuma and/or Dolores Country
Entries due Friday July 27th by 5:00 pm to Erin Gordanier 20090 RD B, Cortez Co 81321
NO call ins after 7:00pm on the 26th 970-529-3291. Check in 9:00 on the 28th in crow’s nest
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Contestant Name: ________________________________________________________
Birthdate: ____________ Gender: ________
Address: ______________________________________________________________________
Phone #: _______________________
Age as of January 1st, 2018: ____ Proof of age req. with entry.
Check one age group: 5 & under: ___6-10____11-14 ____ 15-19 ____
Boys and Girls will run together, placings and points will be separated
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5 & Under: $5 per event- May be lead 6-10 Age Group: $5 per event
____ Mutton Bustin _____ Flag Race
____ Goat Tagging _____ Keyhole Race
____ Keyhole Race _____ Goat Tying
____ Barrel Race _____ Barrel Race
11-14 Age Group: $5 per event 15-19 Age Group: $5 per event
_____ Goat Tying _____ Goat Tying
_____ Flag Race _____ Flag Race
_____ Barrel Race _____ Barrel Race
_____ Steer Daubing _____ Steer Daubing
Family Fun Events: $5 per event
_____ Rawhide Race- Partner: ___________________
_____ Family Baton Race- Partner: _______________
_____ Ribbon Roping- Partner: __________________
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TOTAL EVENT FEES $____________
AMIN FEE $ ____$5_____
TOTAL AMOUNT DUE $_______________
I understand that NO DOGS are allowed on the fairgrounds…….… initials________
COLORADO WARNING
Under Colorado Law, an equine professional is not liable for an injury to or death of a participant in equine activities resulting from the inherent risks of equine activities, pursuant to section 13-21-119, Colorado Revised Statues.
READ THIS DOCUMENT COMPLETELY BEFORE SIGNING. ITS EFFECTIS TO RELEASE MONTEZUMA COUNTY FAIR AND ITS GOVERNING BOARD, THE COUNTY AND STATE OF COLORADO FROM ANY, AND THE MONTEZUMA COUNTY FAIRGROUNDS LIABILITY RESULTING FROM YOUR PARTICIPATION IN THE ACTIVITIES DESCRIBED BELOW, AND TO WAIVE ALL CLAIMS FOR DAMAGES OR LOSSES AGAINST THE COUNTY WHICH MAY ARISE FROM SUCH ACTIVITIES.
PARTICIPANT’S FULL NAME: ________________________________________________________________________
DATE OF BIRTH (MO/DAY/YR): ______________________________________________________________________
ADDRESS: _______________________________________________________________________________________
LOCATION OF ACTIVIY: MONTEZUMA COUNTY FAIRGROUNDS OUTDOOR ARENA
DATE OF ACTIVITY: JULY 28TH, 2018
I, the undersigned participant exercising my own free choice to participate voluntarily in the named above activity, and promising to take due care during such participation, hereby release and discharge, indemnify and hold harmless Montezuma County, Board of Commissioners, Montezuma County Fair board, and their members, officers, agents and employees, Montezuma County Fairgrounds and any other persons or entities acting on their behalf, and the successors and assigns for any and all claims, demands, and causes of action whatsoever, whether presently known or unknown, either in law or in equity, relating to injury, disability, death or other harm, to person or property or both, arising from my participation in and/or presence at the above listed activities.
I acknowledge that I have been informed of the nature of the activities and that I am aware of the hazard and risks which may be associated with my participation in the above-named activities, including the risk of bodily injury, death or damage to property which may occur from known or unknown causes. I understand, accept, and assume all such hazards and risks, and waive all claims against Montezuma County, and any person as set forth above. I understand that I am solely responsible for any cost arising out of any bodily injury or property damage sustained through my participation in normal or unusual acts associated with the above-named activities.
I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my consent and agree to this Release from Responsibility, Assumption of Risk, and Waiver.
READ, UNDERSTOOD AND AGREED TO THIS__________ DAY OF ___________20 _____
Signature of Participation whose printed name appears below:
_________________________________________________________________________________________________
If participant is under 18, his or her parent or legal guardian must also sign below:
I, (printed name) ___________________________________________ am the parent or legal guardian of the participant who has signed above. I have read and I understand the provisions of this document, I consent to the participant taking part in the activities described above, and I fully enter into and agree to the above Release of Responsibility, Assumption of Risk, and Waiver.
__________________________________________________________________________________________________ Parent or Guardian must sign
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