Waiver Participant's Name * First Name Last Name Birth Date * MM DD YYYY Ove 18? * Yes No If under 18, please provide parent or guardian's name and phone number in area below. Minors are required to be supervised by gaurdian at ALL TIMES during Dynasty Arms events. Email * Phone * (###) ### #### Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Assumption of Risk and Release of Claims * I acknowledge that I voluntarily have chosen to join DYNASTY ARMS GUN CLUB. I am aware that activities performed by members such as myself include using firearms at the shooting range and/or using firearms to hunt on Club property. I AM AWARE THAT THESE ACTIVITIES ARE HAZARDOUS ACTIVITIES AND THAT I COULD BE SERIOUSLY INJURED OR EVEN KILLED. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED, AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH OR PROPERTY DAMAGE, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. BY SIGNING THIS DOCUMENT, I AM WAIVING ANY AND ALL LIABILITY ACTIONS WHICH I MIGHT PURSUE AGAINST PALMERTON ROD & GUN CLUB FOR ANY AND ALL BODILY INJURY OR INJURIES, DEATH OR DEATHS, OR PROPERTY DAMAGE, INCLUDING ANY AND ALL LIABILITY ACTIONS ARISING OUT OF NEGLIGENCE ON THE PART OF PALMERTON ROD & GUN CLUB, ITS AGENTS, OFFICERS, AND/OR MEMBERS. I verify this statement by checking this box. As consideration for being permitted by DYNASTY ARMS GUN CLUB to become a member and to participate in the aforementioned activities, I forever release DYNASTY ARMS GUN CLUB, and their respective directors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releasees”) from any and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) my participation in these activities, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Releasee, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND DYNASTY ARMS GUN CLUB, , AND I SIGN IT OF MY OWN FREE WILL. I also understand this release and waiver shall remain in affect while I am a member of the DYNASTY ARMS Gun Club. I acknowledge Emergency Contact Name * First Name Last Name Emergency Contact Phone * (###) ### #### How did you hear about us? Facebook Instagram Friend Newspaper Online article Groupon Would you like to become a member of Dynasty Gun Club? Yes No In the Future Electronic Signature Consent * By clicking here you are consenting to the use of your electronic signature in lieu of an original signature on paper Yes No Thank you!
