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JACK & BECKY DERBY MEMORIAL RODEO TYRA RODEO SATURDAY, MAY 10TH , 2008 10:00AM ROB & BESSIE WELDER PARK HWY 181 NORTH SINTON, TEXAS BUCKLES WILL BE GIVEN TO THE ALL AROUND CHAMPIONS
16453 CR 1726 ODEM, TX 78370 PHONE: 361-244-0510(NO CALLS AFTER 5:00PM PLEASE)
EMERGENCY MEDICAL FORM FOR ALL ROUGH STOCK RIDERSTHE DERBY MEMORIAL TYRA RODEO 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 DERBY MEMORIAL 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.
_______________________ _______________________________ __________________________ _______________________________ Emergency Contact phone number Date
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