A Day in the Ring-Participant Registration
Registration is due no later than March 1st, 2019
Event will be held on Thursday, March 28th, check-in begins at 9:15, show begins at 10:00am. Lunch will be served to all participants.
Email address *
Participant Information (Please fill out all areas)
Gideon *
Your answer
Dyess *
Your answer
Parent Email
Your answer
Ennis *
Your answer
Mrs. Warren *
Your answer
Sex *
Birth date *
Your answer
Age
Your answer
Grade *
Doctor/Phone *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Emergency Contact relationship to participant *
Your answer
Name of person attending show with student *
Your answer
Current phone for companion *
Your answer
Special Needs Information
Nature of Ability (please list diagnosis) *
Your answer
Does student use a walker, wheelchair, or crutches? If yes, please specify *
Does the student have seizures? *
Does the student have diabetes? *
Does the student have allergies? Please specify. *
TShirt Size *
Release and consent for medical treatment
Please make sure to read the following statements and check the boxes at the bottom. By checking the boxes, you are giving your consent and will be recognized as your electronic signature.
I, the parent/guardian of the registrant, agree that I and the registrant will abide by the rules of Ellis County 4-H and Texas A&M AgriLife Extension Service. Recognizing the possibility of physical injury associated with livestock and in consideration for the Ellis County 4-H and Texas A&M AgriLife Extension Service accepting the registrant for its livestock show and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify Ellis County 4-H and Texas A&M AgriLife Extension Service, its affiliated organizations, board and sponsors, their employees and associated personnel, including the owners of the livestock utilized for the Programs, against any claim by or on behalf of the registrant as a result of the registrant’s participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize.As the parent or legal guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions necessary to preserve the life, limb or well-being of my dependent. *
Required
I, the parent/guardian of the registrant, hereby give my consent for photography/videography and the use of said photographs to be displayed on website, Facebook, or other means of advertisement expressly for the enrichment of the A Day in the Ring Livestock Show. *
A copy of your responses will be emailed to the address you provided.
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