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June 26, 2010
NOON
Cole Creek Equestrian Center
4965 Steelhead Lane
Kelseyville
Winners receive a silver belt buckle and
will be announced at the
Lake County Rodeo
Friday July 9, 2010
Name of Child: ____________________________________________
M F_____
Name of Parent or Guardian: _________________________________
Mailing Address: _____________________________________________
C ity: State: ____________________________________
Zip code_______
Phone______________________
Child’s school(if any): _______________________________
Hobbies, Likes, Dislikes, pets name. (Use additional page if needed)
______________________________________________________
______________________________________________________
Parent or Guardian Signature:
__________________________________________
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