Kansas High School Rodeo Association 7762 Old Stage Road Junction City, KS

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1 Kansas High School Rodeo Association 7762 Old Stage Road Junction City, KS Welcome to the Kansas High School Rodeo Season!! We are preparing for the fall season, and it promises to be a great one. Please feel free to contact me via khsrarodeo@gmail.com at any time if questions arise. is my preferred contact. The following pages contain forms and list documents that are required to be filled out and returned to me as soon as possible prior to entering your first rodeo. (These forms must be in hand before you can enter). There is a checklist on the KHSRA state membership form that will ensure that you have all of the forms and documents needed before mailing it to me. Below are a few details that will help if you are a new member to the association. Everyone must call-in or to get entered into the first rodeo. (There are 2 call in days for the first rodeo.) Those days will be posted on the KHSRA website once the schedule is finalized. ( At the first rodeo, we will have a book available to enter all or your choice of the remaining rodeos for the season. Instructions on how to do this will be available there. You will get a printed confirmation of your entries once complete. Please note that when you enter the rodeo this way, you are entered and if you don t show or draw out in time, you will be responsible for your fees. Sunday morning at the first rodeo, there will be a MANDATORY contestant meeting after Church services in the grandstands. Roll call may be taken. We will also take a group photos at this first rodeo for the calendar. (Western dress is required.). We take photos of each class (freshman, sophomores, etc, each event, officers and directors). KHSRA Calendars will be handed out at the last rodeo of the fall season. Once you join, your membership packet that will contain your membership card, back number, and other important information will be available at the first rodeo that you attend in the rodeo office. The rodeo office always opens 2 hours prior to the start time of the rodeo. Back numbers must be worn on contestants backs at all times during the weekend. This means everywhere you go. You must be in western attire 1 hour prior to the start of the rodeo and remain that way until the rodeo is completely over (not just when your event has ended). At each rodeo we also sell ½ & ½ raffle tickets to support the scholarship fund. We encourage everyone to get in on the fun and buy some raffle tickets, ½ of the money goes into the scholarship fund and the other ½ goes to the winner of the raffle drawing each day. Our official newspaper is the Rodeo News. You will receive a subscription as a part of your membership. We also have a website; it is located at The KSHRA facebook page is KHSRA Rodeo Assn. Membership input is always welcomed and appreciated for news articles in the Rodeo News. Cowboy Church is held every Sunday morning at 8:00am unless otherwise specified. We welcome you to the association. If you have any questions please feel free to contact any board member or myself. Board member contacts are on our website in the Contact Us section They are also the ones at the rodeo wearing the ID badges so that members can easily identify them Sincerely, Suzan Adams KHSRA -State Secretary Member packets/back Numbers may be picked at the first rodeo at check in. Contestants, please remember that you must have your back number on, in order to compete. Please make sure to list all addresses that you want on the distribution list. Please print clearly and note any dashes or underline marks in the address. If you have no internet access, please note that as we will be sending all correspondence via unless you specify that you need forms and information mailed via US mail.

2 Kansas High School Rodeo Association Below you will find instructions for filling out the required forms. The forms consist of applications for the National High School Rodeo and the Kansas High School Rodeo Associations. All applications, forms and documents requested must be completed and returned to the State Secretary with your membership dues before you are allowed to enter first rodeo. It is the members/parents responsibility to ensure that all forms are signed and completed. Please double-check all signature requirements (notary if required) and info areas for completeness. Incomplete applications will be RETURNED and may comprise you being able to enter your first rodeo. Explanation of Forms Included in this Packet National High School Rodeo Association Application Both parents must sign this application (even if you are divorced) A total of $ will be submitted with this application you can t waive the insurance or subscriptions to the magazines and you must initial the box on the form Minors Release Form This form must be notarized and SSN is required for W9 and insurance purposes Kansas High School Rodeo Application Complete this form and have both parents sign KHSRA Fund Raiser Responsibility Agreement This form must be signed by both the parent(s) and the contestant. Please read it carefully and understand which option you are choosing because once you sign it and send it in, you can t change your mind. Hospital Release Form & W9 Signed by parent(s) and contestant and make sure W9 has SSN on it (Return members do not need to fill out a W9 if we had one form last year Other documents that must be sent back with the above Copy of birth certificate (new members only) Cost of most recent grade card (2018 fall members must submit spring 2018 grade card, spring 2019 members must submit their fall 2018 grade card). For those of you who competed in the 2018 state finals, I DO NOT need your grade card. Dues for the year are as follows: KHSRA Schedule National Dues $38.00 NHSRA Times $15.00 See website for schedule Insurance (non-waivable) $69.00 Western Horseman Subscription(must initial on National form/non-waivable) $2.00 KHSRA Dues $11.00 Rodeo News $15.00 Total Due for each Contestant $ Make checks payable to KHSRA Mail to: KHSRA Suzan Adams 7762 Old Stage Road Junction City, KS Please contact me if you have any questions: khsrarodeo@gmail.com is the fastest and preferred way to contact me Suzan Adams Important info for the season. We are going to cut the cost of our mailing/copying expenses. Communication will start taking place via and our website It is VITAL that I have current addresses. I would like to have not only the contestant s address, but also at least 1 parent s address for the mailings. I will not send more information than is necessary via . Please make yourself familiar with the KHSRA website as we plan to make membership forms only available via the website next year unless someone does not have internet access.

3 Kansas High School Rodeo Association Membership Application Name: New Member Renewal (First, middle Initial, Last name, no nicknames) Renewal: KHSRA Back #: (same # as last year.) Address: (post office, street address, or 911 address) City,State,Zip / / Age: DOB Name of Parent(s) or Guardian(s): Home Telephone: Cell Phone: mom Cell Phone: dad Contestant s cell phone: Parent s address (all that you want to be on the mailing list: ADDRESS OF EVERYONE WHO WANTS TO BE ON THE KHSRA LIST (we do most of our communication via so make sure that all who need to be in the know are included on this list: (Please print neatly and legibly and underscores and dashes need to be noted so that I understand which is which) I hereby certify that I am enrolled in High School, and will be in the grade and I will graduate in 20 (year). / Signature/date of member / Signature/date of parent / Signature/date of parent SEND FEES AND ALL MEMBERSHIP INFORMATION TO: KHSRA State Secretary Suzan Adams 7762 Old Stage Road Junction City, KS Phone khsrarodeo@gmail.com Checklist of Items to be Returned to the KHSRA State Secretary National Application Form (both parents must sign even if divorced) Minors Release Form & W9 (W9 only if new member) Hospital Release Form (will be ed at a later date form not included in this packet) KHSRA Fund Raiser Responsibility Agreement Form & Dress Code Policy Agreement Enclose a check for $ made payable to KHSRA Kansas High School Rodeo Association Application (include addresses for parent and contestant) Enclose a copy of your birth certificate (new members only) Enclose a copy of your most recent grade card if you competed in the 2018 State Finals I have your last grade card on file and you do not need to submit again. Everyone else must submit one. (must be passing 70% of classes to be eligible to rodeo.) New 2018 fall members enclose your spring 2018 grade card spring new members enclose your fall 2018 grade card

4 National High School Rodeo Association Membership Application [Please Print Clearly or Type & Fill In All Blanks] STATE/ PROVINCE SECRETARY USE ONLY NHSRA MEMBER # Name: Primary Phone:( ) Mailing Address: Other Phone #: ( ) City, State/Province: Zip+4/Postal Code: Country: Address: Date of Birth: Month Day Year Type of Membership: Competing Associate Competing Members are eligible to enter events at qualifying rodeos, compete for awards and scholarships and qualify for the NHSFR. Associate Members are not eligible to enter rodeos. Both categories are eligible for additional benefits as may be currently offered. Gender: Male Female Check One: Rookie (1st year) Member Renewing Member Number of Years in NHSRA [include current year]: Number of Years in JH Division: State/Province Association: Region/District [if applicable]: If you live in a different state than applying for, have you submitted a signed transfer form? Yes No EVENTS As a competing member, you are eligible to enter any of the events offered for your gender. For statistical purposes, please check any and all of the events you are planning to enter any time this rodeo season. BOYS EVENTS: TIE DOWN ROPING STEER WRESTLING BAREBACK RIDING SADDLE BRONC RIDING BULL RIDING TEAM ROPING CUTTING REINED COW HORSE SHOOTING LIGHT RIFLE SHOOTING TRAP GIRLS EVENTS: BARREL RACING BREAKAWAY ROPING POLE BENDING GOAT TYING TEAM ROPING QUEEN CONTEST CUTTING REINED COW HORSE SHOOTING LIGHT RIFLE SHOOTING TRAP Dues and Fees Competing Member: U.S Members: NHSRA Dues, Insurance, NHSRA Times & Western Horseman. $124 Foreign Members: NSHRA Dues, NHSRA Times & Western Horseman. $65 State/ Province Dues $ Region/ District Dues.. $ Dues and Fees Associate Member: U.S Members:... $40 TOTAL: $ Foreign Members:. $65 SCHOOL INFORMATION School Name: City of Attending School: State/ Province of Attending School: School Type: Public Private Homeschool Current Grade: Important Please Initial I understand that I receive a oneyear subscription to Western Horseman magazine as a benefit of my NHSRA membership. $2 of my membership dues will be applied to this one year subscription. Initial Here: READ AND SIGN BELOW We certify that the information supplied in this application is true and correct to the best of our knowledge and belief, and that the student applying for membership meets the qualifications and criteria for membership in the District/Region High School Rodeo Association, the State/Province High School Rodeo Association and that National High School Rodeo Association. By applying for and receiving membership in the District/Region, State/Province and the National High School Rodeo Association, we hereby agree to follow all rules and guidelines set forth by the Region/District, State/Province and the National High School Rodeo Association and to abide by all decision and rulings of the governing committees and boards of these associations. Member s Signature: Date: Mother s Signature: Date: Father s Signature: Date: BOTH PARENTS AND/OR GUARDIANS MUST SIGN APPLICATION. BE SURE TO COMPLETE THE MINORS RELEASE FORM.

5 NATIONAL HIGH SCHOOL RODEO ASSOCIATION (Please Print Clearly or Type and fill in all blanks) NHSRA Membership# Member's Name: Address: City: State: Zip: Telephone#: DOB: Month Day Year MINOR'S RELEASE, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT We, the undersigned, hereby request that the below named minor (minor) be granted permission (1) to enter the restricted area, (2) to participate as a contestant, assistant, official or otherwise in rodeo events, (3) to compete for money, prizes, recognition or reward, (4) to be covered by participants' hospitalization insurance, if applicable, as limited by the master policy (all collectively hereinafter called "permissive entr y "). In consideration of "permissive entry" to minor into the restricted area, which is the area from which admission to the general public is restricted, which includes, but is not limited to the rodeo arena, competition area, chutes, pens, adjacent walkways, concessions, and other appurtenances, we, the undersigned, on behalf of the minor and for ourselves, our personal representatives, heirs, next of kin, spouses and assigns, do hereby: 1. RELEASE, DISCHARGE AND COVENANT NOT TO SUE the rodeo committee, stock contractor, rodeo association, sponsors, arena operators or owners, and each of them, their officers, agents and employees (all hereinafter collectively referred to as "releasees") from any and all claims and liabiltiy arising out of strict liability or ordinary negligence of releasees or any other participant which causes the undersigned injury, death, damages or property damage. We, the undersigned, jointly, severally, and in common, covenant to hold releasees harmless and to indemnify releasees from any claim, judgement or expenses releasees may incur arising out of any of the minor's activities or presence in the restricted area. 2. UNDERSTAND that minor's entry into the restricted area and/or participation in rodeo events contains DANGER AND RISK OF INJURY OR DEATH TO MINOR, that conditions of the rodeo arena change from time to time and may become more hazardous, that rodeo animals are dangerous and unpredictable, and that there is INHERENT DANGER in rodeo which we each appreciate and voluntarily assume because the minor and we choose to do so. Each of the undersigned has observed events of the type that the minor seeks to participate in. We further understand that the arena surface, access ways or lack thereof, lighting or lack thereof, and weather conditions all change and pose a danger to the minor. We further understand that other contestants and participants pose a danger to the minor, but nevertheless, WE EACH VOLUNTARILY ELECT TO ACCEPT ALL RISKS connected with the minor's entry into the restricted area and/or participation in any rodeo events. 3. AGREE that this agreement shall apply to any incident, injury, accident or death occurring on the above date and FOR A PERIOD OF TIME covering any statutory period in which a cause of action may accrue for minors or adults. All subsequent agreements and release documents signed by any of the undersigned shall amplify, but shall in no way limit the provisions of this document. The provisions of this document may be cancelled by any one of the undersigned by delivering to the above rodeo association written cancellation of this agreement which shall be effective 24 hours after the date said cancellation is actually received by the rodeo association. 4. Releasor or parents or guardians of the undersigned minor AGREE TO INDEMNIFY the Releasees and each of them from any loss, liability, damage or costs they may incur due to the presence or participation of the minor in the described activities whether caused by the negligence of the Releasees or otherwise. WE HAVE READ THIS DOCUMENT, WE UNDERSTAND IT IS A RELEASE OF ALL CLAIMS. WE APPRECIATE AND ASSUME ALL RISKS INHERENT IN RODEO. Signature of Natural Father Print Clearly or Type Name of Natural Father Signature of Natural Mother Print Clearly or Type Name of Natural Mother Signature of Legal Guardian Print Clearly or Type Name of Legal Guardian Signature of Member Print Clearly or Type Name of Member On this day of 20, before me, personally appeared------,-,---...,...-.,.,...,---,-,-----,---, Notary: List all Names Notorized to me known to be the persons who executed the foregoing Release and acknowledged that they signed same as their free act and deed. My Commission Expires: Notary Public *Both parents and member or legal guardian must sign this form in the appropriate places above. If only one parent is signing, please note reason on signature line. For example, DECEASED, DIVORCED AND FULL CUSTODY, ETC. All signatures must be witnessed by a notary and listed as personally appearing in the appropriate place on the form. Be sure that notary signs, dates and places his/her seal on the form. Please return original Minor's Release form to the state/province secretary with membership application and fees.

6 KHSRA/KJHSRA HOSPITAL RELEASE FORM We, the parents and/or guardians of: Please print name of Contestant give EMT s, Hospital, physicians on the medical staff of the hospital and ambulance attendants that the Qualifying Rodeo or State Board chooses for emergency treatment, permission to administer NECESSARY EMERGENCY treatment for injuries he or she may incur while participating in the state approved activities. We understand that each contestant must be and is covered by medical insurance. We hereby release the designated local hospital, physicians, medical staff, ambulance attendants, EMT s, all rodeo sponsors and committee s from all Liability. Signed: And (Parent or guardian must sign regardless of age of Contestant)

7 As a member of KHSRA, it is your responsibility to meet the following responsibilities and obligations. If any KHSRA member or parent has any questions about these responsibilities, please feel free to contact your State President, National Director, State Secretary or a KHSRA Board member. The contact information for these people can be found on our website Please read the following agreement and send a signed copy with your membership information to the State Secretary. Make and retain a copy for your records. Each KHSRA member is required to submit his or her grade card or school transcript to the KHSRA State membership Secretary. Grade cards must be submitted to the State Secretary for grade verification prior to the first rodeo they are entering for both semesters, or they will not be allowed to enter the rodeo. Returning KHSRA members who competed in the 2018 State Finals are not required to turn in a grade card with the membership forms as I have your grade card on file from state finals. For the (2018) fall season, you will submit your grades from the previous (2018) spring semester. For the (2019) spring season you will submit your grades from the previous (2018) fall semester. Fall 2018 members, you must choose one of the following options as your fund raiser agreement. Please understand each option and what it entails. Once this agreement has been signed, you have committed to fulfilling this financial agreement. Both the contestant AND the parent(s) need to sign this form. All monies are due January 12, After that date there will be a $50.00 late fee. The late fee and the full amount of your financial agreement must be turned in prior to entering your first spring rodeo. If you do not have this money turned in by April 1, 2019 you will not be allowed to compete in the KHSRA State Finals. Members who join in the spring (see below) Option # 1 - Sell 20 $20.00 each Option # 2 Turn in $ in cash donations. Please list your choice here New 2019 spring members, will be required to acquire $400 in donations turned into me by April 1, Members joining in the spring DO NOT have the option of selling calendars. You must obtain $ in sponsorship donations because we order the calendars in the fall and distribute them then. As parents of the KHSRA member, you agree to be financially responsible for this mandatory requirement. KHSRA member signature Please print your name KHSRA parent signature please print your name *Calendar monies, Raffle Tickets and Sponsorships monies pay for Year End Awards, State Finals, and National Team ** If at any point during the season, you decide that you are not returning, please let the State Secretary know (Suzan Adams).

8 Contestants are required to be in full western dress one hour before the rodeo begins. The start of the rodeo does not include the cutting or reined cow horse events. However, if you are in the arena, during the cutting contest, you are required to be in full western dress. Contestant and helper (adult and/or parent) if in arena must be in full western dress code. Contestant must be in western attire to check in with the rodeo secretary if it is one hour or less before/after the start/end of the rodeo. Contestants are required to be in western dress until the rodeo is complete. If the rodeo is a co-sanction rodeo with KJHSRA, you must remain in western attire until your rodeo is complete. For example, if you are a high school member and the high school rodeo ends first, you can change after the last person goes in the last event even if the Jr. High rodeo is still going on. Your back numbers go on your back, not pinned to your belt on your hip. Violators of the dress code policy while in the arena can be assessed a $25.00 fine by the executive board for not following the dress code (western boots, long sleeved collared button down shirt and cowboy hat with a minimum of 2 ½ brim and 5 inch crown. I understand the western dress code rule and policy. Signature of Contestant Signature of parent

9 Form W-9 (Rev. December 2011) Department of the Treasury Internal Revenue Service Name (as shown on your income tax return) Request for Taxpayer Identification Number and Certification Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. Business name/disregarded entity name, if different from above Check appropriate box for federal tax classification: Individual/sole proprietor C Corporation S Corporation Partnership Trust/estate Exempt payee Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Other (see instructions) Address (number, street, and apt. or suite no.) Requester s name and address (optional) City, state, and ZIP code List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on the Name line to avoid backup withholding. For individuals, this is your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter. Social security number Employer identification number Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding, and 3. I am a U.S. citizen or other U.S. person (defined below). Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 4. Sign Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Purpose of Form A person who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage interest you paid, acquisition or abandonment of secured property, cancellation of debt, or contributions you made to an IRA. Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN to the person requesting it (the requester) and, when applicable, to: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners share of effectively connected income. Date Note. If a requester gives you a form other than Form W-9 to request your TIN, you must use the requester s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien, A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States, An estate (other than a foreign estate), or A domestic trust (as defined in Regulations section ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax on any foreign partners share of income from such business. Further, in certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid withholding on your share of partnership income. Cat. No X Form W-9 (Rev )