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Alice Youth Rodeo Association TYRA RODEO SATURDAY, APRIL 12TH , 2008 9:00AM
Jim Wells County Fair Grounds HWY 281 South Alice, TEXAS
SIX ALL AROUND BUCKLES TO BE AWARDED!!
16453 CR 1726 ODEM, TX 78370 PHONE: 361-244-0510(NO CALLS AFTER 5:00PM PLEASE)
EMERGENCY MEDICAL FORM FOR ALL ROUGH STOCK RIDERSTHE ALICE YOUTH RODEO ASSOC. CANNOT AND WILL NOT ASSUME ANY FINANCIAL OBLIGATIONS, BUT WISHES TO PROVIDE THE BEST SERVICES POSSIBLE IN AN EMERGENCY. PLEASE READ THE FOLLOWING STATEMENT AND FILL IT OUT CAREFULLY BEFORE SIGNING. In case of an accident or serious illness, I request the Alice Youth Rodeo Association TYRA Rodeo to contact me. I hereby authorize the Emergency Medical Personnel to treat or transport my child, ________________________________, to the nearest hospital for treatment. I also authorize the attending hospital and doctors to treat my child as necessary.
_______________________________ _______________________________ Signature of parent or guardian Printed name of parent or guardian
______________________________ _______________________________ Emergency Contact phone number Date |