Skiatook Roundup Club

Skiatook Roundup Club

PO Box 672

Skiatook, Ok 74070

Membership Card 20__                                             Card#____

Single $15.00__Family$20.00___

 

Name: _____________________________________________

Spouse: ____________________________________________

Address: __________________________________________

City: _____________ State: ___________ Zip: ____________

Phone (1):_____________Phone (2):_________Email: _________________

Children:

1.________________________________ D.O.B ____________________

2. _______________________________ D.O.B ____________________

3. _______________________________ D.O.B ____________________

4. _______________________________ D.O.B ____________________

5. _______________________________ D.O.B ____________________

6. _______________________________ D.O.B ____________________

 

This is between the Skiatook Roundup Club and the names listed above:

1.)     The members must abide by all rules and bylaws set forth by the Skiatook Roundup Club.

2.)    All decisions must be brought before the Board

3.)    I understand there are certain risks and dangers involved in participating as a member of the Skiatook Roundup Club and I herby assume all risk of injury sustained at person(s) or loss to my property resulting form my participation in a club event.

4.)    I do hereby release the Skiatook Roundup Club and the AT Ferree Estate and all members from all claims, demands, actions, and causes of action of any sort of injury sustained.

 

Playday Release

 

Emergency contact:_________________________________

Phone (1): ________________ Phone (2): _______________

I prefer my child(s) to be taken to which Hospital:____________________

List medications your child is on: __________________________________

Drug Sensitivities: _____________________________________________

If more space needed please list on back.

 

I HEREBY AGREE TO ALL LISTED ABOVE

 

Signature: ________________________  Date:_______________________