National Junior. Bullriders Assn. Membership & Release To Ride
Complete this form, have signature notarized, and send it with your fee and copy of Birth Cert. to:
National Junior Bullriders
435153 E 200 Rd.
Vinita, OK 74301

Name:_________________________________________________
Address:_______________________________________________
City______________________State____________Zip__________
Phone:___________________________Cell #_________________

Date of Birth_____________ Age group competing in:___________
T-Shirt size:_____Coat size:________ SS#___________________

____I am enclosing $40 National Fee          (add'l State Fee is $ _________)     

 ____I am enclosing Copy of Birth Certificate

PARENTS CONSENT AND GENERAL RELEASE

We certify that the age and date of birth of the above child is correct, and we hereby consent to our child joining the National Jr. Bullriders Association ( NJBRA)In consideration of allowing our child's membership, we agree we will in no manner hold the NJBRA, or its agents, officers, directors, rodeo producers or any individuals connected with the rodeo or association liable or responsible in case of accident or injury to the contestant, stock, or property and further hereby RELEASE and agree to hold harmless the NJBRA,directors,officers, rodeo producers or any individuals connected with the rodeo or association from any and all liability for damage to person or property as a result of or related to the participation of any child. We are fully aware of the dangers involved and have read this release and fully understand its terms.

Signed ___________________________Signed ________________________
               ( Mother or Legal Guardian)                             ( Father or Legal Guardian)
(Signatures must be notarized)

COUNTY OF_______________
STATE OF_________________
This instrument was acknowledged before me this ____day of__________, 20___.

Notary Public___________________________________________________
Commission Expires_____________________________________________