Kansas Jr. High School Rodeo Association 7762 Old Stage Road Junction City, KS 66441 785-238-7192 khsrarodeo@gmail.com Welcome to the 2018-2019 Kansas Jr. 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 email khsrarodeo@gmail.com at any time if questions arise. Email 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 KJHSRA 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 email to get entered into the first rodeo. (There are 2 call in days for the first rodeo.) Those days will be posted on the KJHSRA website once the schedule is finalized. (www.khsra.net/schedule.html) At the first rodeo, we will have a computer 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 association photos at the first rodeo of the fall. Western dress is required for this. We will take the pictures Sunday immediately after Cowboy Church services. 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). 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 http://ww.khsra.net. The KSHRA facebook page is KHSRA. Membership input is always welcomed and appreciated for news articles in the Rodeo News. Cowboy Church is held every Sunday morning at 8:00m 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 www.khsra.net/contact.html. They are also the ones at the rodeo wearing the ID badges so that members can easily identify them Sincerely, Suzan Adams KHHSRA -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 email addresses that you want on the email 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 email unless you specify that you need forms and information mailed via US mail.
Kansas Jr. High School Rodeo Association Below you will find instructions for filling out the required forms. The 2018-2019 forms consist of applications for the National High School Rodeo and the Kansas Jr. 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 $120.00 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 & W9 Form This form must be notarized and SSN is required. W9 form is required for new members only Kansas Jr. High School Rodeo Application Complete this form and have both parents sign This is used for the student directory. Also make SURE that I have the contestant s email address as well as each parent s email address that wishes to be on the email list. We will be corresponding via email to save postage this season and to improve communication. It is your responsibility to let me know if your email address changes!! If you do not have internet access please note that on the forms. KJHSRA Fund Raiser Responsibility Agreement & Dress Code Policy 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 Signed by parent(s) and contestant Other documents that must be sent back with the above Copy of birth certificate 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). Those who competed in the 2018 Jr. High State Finals I don t need your grades, I have them on file. Dues for the 2018-2019 year are as follows: National Dues, NHSRA Times, Insurance (non-waivable), Western Horseman Subscription(must initial on National form/non-waivable) $80.00 KJHSRA Dues $25.00 Rodeo News (non-waivable) $15.00 Total Due for each Contestant $120.00 Make checks payable to KJHSRA Mail to: KJHSRA Suzan Adams 7762 Old Stage Road Junction City, KS 66441 Please contact me if you have any questions: khsrarodeo@gmail.com 1-785-238-7192 email is the fastest and preferred way to contact me Suzan Adams 2018-2019 KJHSRA Schedule See website www.khsra.net Important info for the 2018-2019 season. Communication takes place via email and our website www.khsra.net/jrhigh.html and our facebook page (KHSRA). It is VITAL that I have current email addresses. I would like to have not only the contestant s email address, but also at least 1 parent s email address for the mailings. I will not send more information than is necessary via email. 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.
Kansas Jr. High School Rodeo Association Membership Application 2018-2019 Name: New Member Renewal (First, middle Initial, Last name, no nicknames) Renewal: KJHSRA 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 Email address: Contestant s email address: (Please print neatly and legibly and underscores and dashes need to be noted so that I understand which is which) (Please include 1 current email address for the member, plus at least 1 for the parent!! We will be sending correspondence via email so it is VERY important that we have email addresses of everyone who wishes to receive the newsletters and other announcements. If you do not have internet access please note that.) I hereby certify that I am enrolled in 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: KJHSRA State Secretary Suzan Adams 7762 Old Stage Road Junction City, KS 66441 785-238-7192 Email: khsrarodeo@gmail.com Checklist of Items to be Returned to the KJHSRA State Secretary National Application Form (both parents must sign even if divorced) Minors Release Form Hospital Release Form and Western Dress Code Policy Agreement KHSRA Fund Raiser Responsibility Agreement Form & W9 (W9 for new members only) Enclose a check for $120.00 made payable to KJHSRA Enclose a copy of your birth certificate (new members only) Kansas High School Rodeo Association Application (include email addresses for parent and contestant) Enclose a copy of your most recent grade card 2018 fall members enclose your spring 2018 grade card - 2019 spring new members enclose your fall 2018 grade card contestants who competed in the Jr. High Finals in 2018 don t need to send their grade card - I have it on file.
NHSRA Jr. High Division Membership Application 2018-2019 [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: Email Address: Date of Birth: Month Day Year Gender: Male Female Check One: Rookie (1st year) Member Renewing Member Number of Years in NHSRA [include current year]: 1 2 3 4 Number of Years in JH Division: 0 1 2 3 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 BOYS EVENTS: BAREBACK STEER RIDING BREAKAWAY ROPING BULL RIDING CHUTE DOGGING GOAT TYING RIBBON ROPING SADDLE BRONC STEER RIDING TIE-DOWN ROPING TEAM ROPING LIGHT RIFLE SHOOTING 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. GIRLS EVENTS: BARREL RACING BREAKAWAY ROPING GOAT TYING RIBBON ROPING POLE BENDING TEAM ROPING LIGHT RIFLE SHOOTING Dues and Fees -Competing Member: U.S Members: NHSRA Dues, Insurance, NHSRA Times & Western Horseman. $80 Foreign Members: NSHRA Dues, NHSRA Times & Western Horseman. $59 State/ Province Dues $ Region/ District Dues.. $ Dues and Fees- Associate Member: U.S Members:... $40 TOTAL: $ Foreign Members:. $65 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.
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.
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)
The KJHSRA Board of Directors, would like to make clear, the following mandatory responsibilities and obligations. If you as a KJHSRA member and parent have any questions about this document, please feel free to contact your state secretary, national director or KJHSRA board member. Please, read and sign both agreements. Send one to the state secretary with your membership information. Retain the second copy for your records. Each KJHSRA member is required to submit his or her grade card or school transcript to the KJHSRA state membership secretary. These are required at the end of each semester of the school year to be eligible to compete in the up coming rodeo season. To be eligible to compete in the KJHSRA state finals, each KJHSRA member is required to submit a Scholastics Eligibility Report signed by the principal of contestant s school. Each member is required to raise $250.00. The member can either choose to sell raffle tickets (for a prize determined later or get $250 sponsorship donations). As parents of the KJHSRA member, you agree to be financially responsible for this mandatory requirement. (KJHSRA member signature) (Please print your name) (KJHSRA parent signature) (Please print your name) (KJHSRA parent signature) (Please print your name)
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
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 301.7701-7). 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. 10231X Form W-9 (Rev. 12-2011)