Kansas High School Rodeo Association 7762 Old Stage Road Junction City, KS 66441 785-238-7192 [email protected]

Welcome to the 2016-2017 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 email [email protected] 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 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 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 KHSRA 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 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 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 8:00am 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 – 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 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 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 High School Rodeo Association Below you will find instructions for filling out the required forms. The 2016-2017 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 $150.00 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

 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 (2016 fall members must submit spring 2016 grade card, spring 2017 members must submit their fall 2016 grade card). For those of you who competed in the 2016 state finals, I DO NOT need your grade card.

Dues for the 2016-2017 year are as follows: National Dues $38.00 NHSRA Times $15.00 Insurance (non-waivable) $69.00 Western Horseman Subscription(must $2.00 initial on National form/non-waivable)

KHSRA Dues $11.00 Rodeo News $15.00 Total Due for each Contestant $150.00 Make checks payable to KHSRA Please contact me if you have any questions: Mail to: [email protected] KHSRA 1-785-238-7192 email is the fastest and Suzan Adams preferred way to contact me 7762 Old Stage Road Junction City, KS 66441

Suzan Adams

2016-2017 KHSRA Schedule

See website for schedule www.khsra.net

Important info for the 2016-2017 season. We are going to cut the cost of our mailing/copying expenses. Communication will start taking place via email and our website www.khsra.net. 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.

National High School Rodeo Association Membership Application 2016-2017

STATE/PROVINCE SECRETARY USE ONLY NHSRA Member ship #

(Please Pr int Clear ly or Type and Fill In All Blanks)

Name:_________________________________________________________________________________________________ Mailing Address:__________________________________________________________ Phone:(____) __________________ City, State/Province:_________________________________________________ Zip+4/Postal Code:____________________ Country:________________________________

Gender:

Male

Female

Cell Phone:(____) __________________

Email Address:__________________________________________________________________________________________ State/Province Attending School In:_________________________________ School Type:

Public

Date of Birth: Month:___________ Day:__________ Year:________ Current Grade in School: Number of AQHA Registered Horses:________________________

Private

9

Home

10

Number of Years in JH Division:

11

0

1

12 2

3

State/Province Association in which you are applying for membership:______________________________________________ If you live in a different state than the one you are applying for, have you submitted a signed transfer form? Which Region/District (if applicable):__________ Number of Years in NHSRA (include current year): Check One: Dues and Fees Competing Member

Rookie (1st year) Member

NHSRA Dues, NHSRA Times, Western Horseman and Insurance ................ $124.00 (U.S.) or $65.00 (Foreign)

OR Associate Member (non competing) $40.00 (U.S.) or $65.00 (Foreign) Total ...................................................................... $___150.00____ 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

Gir ls Events Barrel Racing Pole Bending Queen Contest Goat Tying Breakaway Roping Team Roping Cutting Reined Cow Horse

1

No

2

3

4

Renewing Member 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 benefi ts as may be currently offered.

State/Province Dues .............................................. $_______ Region/District Dues............................................. $_______

Yes

Impor tant – Please Initial I understand that I receive a one-year subscription to Western Horseman magazine as a bene¿t of my NHSRA membership. Two dollars of my membership dues will be applied to this one-year subscription. Initial Here:_______________ If you are a new member, how did you learn about NHSRA?

Website Friend or Relative Trade Show Booth

Print Advertisement (Which Publication) __________________

Membership Poster Television Advertising

Other (Please List) __________________

FFA/School Poster Facebook or Social Media

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 quali¿cations 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 COMPLETE THE RELEASE FORM ON THE REVERSE SIDE OF THIS APPLICATION

NHSRA Membership # ____________________

NATIONAL HIGH SCHOOL RODEO ASSOCIATION (Please Print Clearly or Type and fill in all blanks)

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 entry”). 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.

Kansas High School Rodeo Association Membership Application 2016-2017 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 Email address (all that you want to be on the mailing list: __________________________________________________________________________________________ Contestant’s email address: __________________________________________________________________ (Please print neatly and legibly and underscores and dashes need to be noted so that I understand which is which)

Facebook Account(s) for those who want to be on the KHSRA Facebook page: ___________________________________________________________________________________________ (Please include 1 current email address for the member, plus at least 1 for the parents!! 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 _________________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 66441 Phone 785-238-7192 Email: [email protected]

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) Kansas High School Rodeo Association Application (include email addresses for parent and contestant) Hospital Release Form (will be emailed at a later date – form not included in this packet) KHSRA Fund Raiser Responsibility Agreement Form Enclose a check for $150.00 made payable to KHSRA Enclose a copy of your birth certificate (new members only) Enclose a copy of your most recent grade card – if you competed in the 2016 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 2016 fall members enclose your spring 2016 grade card 2017 spring new members enclose your fall 2016 grade card

2016-2017 Kansas High School Rodeo Association Responsibility Agreement 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 – http://www.khsra.net/contact.html. 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 2016 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 (2016) fall season, you will submit your grades from the previous (2016) spring semester. For the (2017) spring season you will submit your grades from the previous (2016) fall semester. Fall 2016 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 21, 2017. 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, 2017 you will not be allowed to compete in the KHSRA State Finals. – Members who join in the spring (see below)

Option # 1 - Sell 20 calendars @ $20.00 each

Option # 2 – Turn in $400.00 in cash donations. Please list your choice here ________________________________________________

New 2017 spring members, will be required to acquire $400 in donations turned into me by April 15, 2017. Members joining in the spring DO NOT have the option of selling calendars. You must obtain $400.00 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).

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)

W-9

Form (Rev. December 2011) Department of the Treasury Internal Revenue Service

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.

Name (as shown on your income tax return) 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.

Social security number

Note. If the account is in more than one name, see the chart on page 4 for guidelines on whose number to enter.

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 ▶

Date ▶

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.

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)