Teller County Shooting Society (TCSS) P. O. Box 548; Woodland Park, CO Membership Application
|
|
- Felicity Wilkins
- 5 years ago
- Views:
Transcription
1 Teller County Shooting Society (TCSS) Application Instructions: Revised 25 January, Please fill in all the blanks on the application that apply. 2. Include your NRA membership number and expiration date. Please include a copy of your NRA card or a label from an NRA magazine received as a direct result of your membership. 3. List any Associates (spouse, children under 18) that you would like on your membership. Please list individual names and dates of birth. 4. Be sure to sign your application. 5. See the payment worksheet for initiation fee waiver and pro-rating of general membership dues if applicable. Include a copy of your waiver credentials as required. 6. Review and sign the GCSSC Liability Release & Waiver. 7. Include your check for the initiation fee and full payment of dues for the level of membership you have selected. 8. Please make a copy of your completed application, NRA verification, liability waiver, and your payment for your files. 9. Send all documents to. 10. Upon receipt, the Board of Directors (BoD) will review your application and, when the decision has been made, you will be notified. If accepted, you will be added to the membership distribution list and thereby notified of all membership meetings, club events, and other pertinent information. Thank you for your interest in the Teller County Shooting Society! For any further membership information or questions about the application process, please contact our Membership Secretary using the contact information available on the TCSS website:
2 Revised 25 January, 2019 Teller County Shooting Society (TCSS) DATE: Last Name: First Name: M.I.: Date of Birth: Sex: M F Mailing Address: City: State: ZIP: Home Phone: Business Phone: Mobile Phone: NRA Membership #: Expiration Date: (Proof of NRA membership is required within two months of this application s date per Article III, Section F of the Teller County Shooting Society By-laws.) Please list any associates to be included in this membership here. An associate is a spouse or child less than 18 years of age of the primary member. Name Relation (circle one) Date of Birth I am applying for the following TCSS membership category. Please check only one. See payment worksheet for waiver of initiation fee and pro-rating of general memberships. General: An initiation fee of $200 plus $150 dues with application. Annual dues and one guest per month. Bronze: An initiation fee of $200 plus $500 dues with application. No annual dues for five years. Silver: An initiation fee of $200 plus $800 dues with application. No annual dues for ten years. Gold: An initiation fee of $200 plus $1,400 dues with application. No annual dues for fifteen years. Platinum: An initiation fee of $200 plus $1,800 dues with application. No annual dues for life of applicant. I certify that I am a citizen or legal resident of the United States of America; that I am not prohibited from possessing a firearm under the laws of the United States or the State of Colorado; and that, if admitted to membership, I will fulfill the obligations of good sportsmanship and citizenship and abide fully with the By-Laws and Range Rules of the TCSS. Signature: Board Member Authentication:
3 Revised 25 January, 2019 Teller County Shooting Society (TCSS) Payment Worksheet: Description Price Initiation Fee: Members of the U.S. Armed Services on active duty, honorably discharged veterans of the U.S. Armed Services, retired members of U.S. law enforcement, retired U.S. firefighters, or CC&V Employees (please provide supporting documents) $ 0.00 All Others $ Membership Dues General Membership Received 1/1 2/28 Received 3/1 6/1 $ $ Received 6/2 9/1 $ Received 9/2 12/31 $ Bronze Membership $ Silver Membership $ Gold Membership $1, Platinum Membership $1, Total Included: Note: Initiation fees and dues are NOT refundable once accepted as a member of TCSS. Please be aware that the TCSS is a volunteer organization and in order to continue our build out of the range and staff events we need members to pitch in and help out on a variety of projects. Below, please indicate what skills and/or volunteer time you may be able to provide and/or on which projects you would like to be involved: Carpentry General Construction Special events Painting Asphalt/concrete Sight-in days General labor Light/heavy equipment Donation of building materials Becoming a NRA Range Safety Officer Other (describe) Answering the questions below is optional: Do you currently hold any NRA certified instructor credentials? Yes No If yes, which one(s)? How did you hear about us? Newspaper Event Drive by sign Mail/Store/Flyer Internet/Website Referral (Who?) Which of the following interests you? Handgun Rifle Shotgun Training/Instruction Hunter Education Shooting Competition Other Have you completed any NRA instructional programs? Yes No If yes, which one(s)?
4 Teller County Shooting Society (TCSS) Gold Camp Shooting Sports Center Liability Release and Waiver Revised 25 January, 2019 I. Intent and Purpose Teller County Shooting Society, Inc., a Colorado non-profit corporation ( TCSS ) owns and operates the Gold Camp Shooting Sports Center in Teller County, Colorado ( GCSSC ). The GCSSC provides a venue for outdoor shooting sports to its members including, but not limited to, handgun and rifle ranges, skeet and trap ranges and archery ranges. As a prior condition to using the GCSSC facilities, all members and their guests are required to read and sign this Liability Release & Waiver, which releases the TCSS and its affiliates, subsidiaries, partners, officers, directors, employees, and agents from any and all claims for mental/physical, bodily injuries or other damages resulting from or incidental to a member s or guest s use of the GCSSC facilities and participation in activities on GCSSC property. Any member or guest who elects not to sign this Liability Release & Waiver is prohibited from entering the GCSSC property and from using the GCSSC facilities. WHEREFORE,, a Member of TCSS, or Guest of, in consideration of being permitted entry to and/or use of the GCSSC property and facilities for whatever purpose including, but not limited to, use of firearms and/or other weapons by him/her including, but not limited to, crossbows and long bows, and with full knowledge that firearms and/or other weapons are used and discharged on the GCSSC property, the Member/Guest agrees as follows: II. Assumption of Risk Member/Guest understands that engaging in or being present during shooting sports is an inherently dangerous activity, and that certain risks and dangers may occur in connection with activities at the GCSSC. Member/Guest, on behalf of himself or herself, and his/her heirs, representatives, successors, and assigns, hereby releases and forever discharges TCSS and its affiliates, subsidiaries, partners, officers, directors, employees, and agents from any and all liability or claims which Member/Guest may incur as a results of death, loss, injury, or damage which may be incurred while engaged in any activities on the GCSSC property, and hereby states that he/she affirmatively assumes any and all risks attendant with the above activities. Among the risks are the following: (1) the nature of the activity itself; (2) the acts or omissions, negligence in any degree, of any other person present at the GCSSC; (3) apparent defects or conditions in equipment or property supplied by TCSS, the GCSSC, or other persons or entities; (5) acts of the Member/Guest, his/her agents or guests, or other participants in any activity; (6) the physical condition of the Member/Guest and his/her agents or guests, or their own acts or omissions; (7) first aid, emergency treatment or other services rendered by any person; (8) absence of any Range Safety Officer ( RSO ) or supervisor of any activities; and, (9) the absence of, misuse of, or defect in any life-saving equipment. The Member/Guest understands and acknowledges the before mentioned list is not complete or exhaustive and that other risks known or unknown, identified or unidentified, anticipated or unanticipated may also result in injury, death, illness, disease, or damage. The Member/Guest expressly accepts those risks not specifically listed before as well. III. Release and Indemnity The Member/Guest herby voluntarily releases and forever discharges TCSS and its affiliates, subsidiaries, partners, officers, directors, employees, and agents from any and all liability, claims, demands, actions or rights of action which are related to, arise out of, or are in any way connected with Member s/guest s and his/her agents and guests use of the GCSSC, and for any and all injury, death, illness, disease or damage to Member/Guest and hi/her agents and guests. Member/Guest
5 Revised 25 January, 2019 Teller County Shooting Society (TCSS) further agrees, promises, and covenants to hold harmless, defend and indemnify TCSS and its affiliates, subsidiaries, partners, officers, directors, employees, and agents from any and all loss, liability, cost, claims, demand and expense (including reasonable attorney s fees and litigation costs at trial, on appeal or in settlement) and from any other costs incurred in connection with claims for Member Initials Guest Initials bodily injury, loss of life or property, damage to the Member/Guest or is/her agents or guests, or which the Member/Guest or hi/her agents or guests may negligently or intentionally cause to anyone in the course of their use of the GCSSC. IV. Covenant Not to Sue Member/Guest further agrees, promises, and covenants not to sue, assert or otherwise maintain or assert any claim against TCSS or its affiliates, subsidiaries, partners, officers, directors, employees, and agents for any injury, death, illness, disease, or damage or which the Member/Guest has assumed the risk pursuant to Article III above, or for which the Member/Guest has agreed to release and indemnify pursuant to this Liability & Release/Waiver. In signing this document, the Member/Guest fully recognizes that, except as otherwise provided herein or at law or equity, if anyone if hurt on property, is damaged while Member/Guest is engaged in use of the GCSSC, he/she will have no right to make a claim or file a lawsuit against TCSS or its affiliates, subsidiaries, partners, officers, directors, employees, and agents. Member/Guest understands and acknowledges that by signing this document he/she has given up certain legal rights and/or possible claims which he/she might otherwise assert or maintain against TCSS or its affiliates, subsidiaries, partners, officers, directors, employees, and agents or other persons or entities. The Member/Guest understands and acknowledges that, except as otherwise provided herein or at law or equity, by signing this document he/she has assumed responsibility and legal liability for the claims or other legal demands, including defense costs, which may be asserted by his/her agents and/or guests against him/her as a result of their use of the GCSSC. TCSS has adopted the Gold Camp Shooting Sports Center Rules to ensure a safe, accident-free shooting environment and to ensure an enjoyable experience for its members and their guests. All members and guests are required to follow those Rules at all times which on the GCSSC property. TCSS reserves the right, in its sole discretion, to modify those Rules at any time. The undersigned agrees to abide by all such rules and regulations as adopted by TCSS from time to time. Member/Guest expressly agrees that this Liability Release & Waiver is intended to be as broad ad inclusive as permitted by law and that if any provision of this Liability Release & Waiver is held invalid or otherwise unenforceable, the enforceability of the remaining provisions shall not be impaired. No remedy conferred by any of the specific provisions of this Liability Release & Waiver is intended to be exclusive of any other remedy, and each and every remedy shall be cumulative and shall be in addition to every other remedy now or hereafter existing at law or in equity or by statute or otherwise. The election of any one or more remedy hereunder by TCSS shall not constitute any waiver of TCSS s right to pursue other available remedies. This agreement binds the Member/Guest and his/her heirs, next of kin, assignees, personal representatives, administrators, and executors. THIS MEMBER/GUEST AFFIRMATIVELY STATES THAT HE/SHE IS UNDER NO DURESS OR UNDUE INFLUENCE AND IS SIGNING THIS LIABILITY RELEAES & WAIVER OF HIS/HER OWN FREE WILL, AND THAT HE/SHE HAS READ AND FULLY UNDERSTANDS ALL OF THE TERMS CONTAINED HEREIN. If a Guest is signing, the sponsoring Member must also sign.
6 Teller County Shooting Society (TCSS) Revised 25 January, 2019 Member or Associate Signature Guest Signature Print Name Date Print Name Date
South Carolina s Official Training Grounds Corporate Membership Application 2015
South Carolina s Official Training Grounds Corporate Membership Application 2015 SCOTG 8524 Neely Ferry Rd Laurens SC 29360 Please print clearly and provide a copy of all applicants photo IDs or CWPs with
More informationTop Shot Membership INDIVIDUAL & FAMILY MEMBERSHIP MEMBERSHIP APPLICATION AND AGREEMENT INSTRUCTIONS
Top Shot Membership MEMBERSHIP APPLICATION AND AGREEMENT INSTRUCTIONS The Membership Application package consists of the following pages: Membership Application and Agreement (1 page) ( Application ) Terms
More informationPlease fill out both sides of this form!!!
$ # Circle one: Mixed Doubles Rockbridge Hunt Hunter Pace & Trail Ride Please fill out both sides of this form!!! Entry fee: Adult rider (18 and over) -- $35 per horse Junior rider (under 18) -- $20 per
More informationFlorida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers)
Florida Waiver (Commercial) (All parents of minors who are Florida residents must sign both the Florida commercial and non-commercial waivers) (Commercial Activity Providers) WAIVER AND RELEASE OF LIABILITY
More information2016 5K Reindeer Run/Walk Team Registration
2016 5K Reindeer Run/Walk Team Registration Team Registration Forms and Waiver must be fully completed and received by December 2 nd in order to receive the $20/person group rate; Minimum of 3 people per
More informationO*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017
O*H*I*O MASTERS SWIM CLUB (Old Hearts Inspiring Others) CLEVELAND - WEST SIDE Swim Workouts WINTER, 2017 COACHED WORKOUTS for WINTER 2017 - We offer workouts overseen by experienced coaches. All adult
More informationANNUAL LAKE ERIE OPEN WATER CLASSIC
Sunday, July 19, 2015 Sanction Number: EVENT INFORMATION EVENTS: There will be ½-Mile, 1-mile and 2-mile swims on a triangular course in Lake Erie. The start will be in the water. The finish will be on
More informationEast Lake Girls Lacrosse 2018 Spring Registration Form. Waiver and Release Form:
East Lake Girls Lacrosse 2018 Spring Registration Form Name: Parent Name: Emergency Number: Email: Address: City: ZIP: Phone Number: Grade: Age: Birth date: School: Position: Shirt Size Short Size Registration
More informationDate of Birth Address City State Zip
RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE. You have the right to consult
More informationMajors Gun Club Greenville, Texas License To Carry A Handgun (LTC) Training
Majors Gun Club Greenville, Texas License To Carry A Handgun (LTC) Training Fill in the attached Student Information Sheet and return it to me not later than three days prior to the class date. Jack Sukenik
More informationMembership Registration Form
Today s Date: Leeward Judo Club Membership Registration Form Primary Dojo Location (Check box): Pearl City Waipahu Student Information: Name (First, MI, Last) Date of Birth Age Sex Male Female Address
More informationLOCATION & DIRECTIONS:
to benefit Malachi Center s 27th Annual Lake Erie Open Water Swim Urban Kids Swim Camp Sponsered by O*H*I*O Masters Swim Club, Saturday, July 16, 2016 Sanctioned by: Lake Erie LMSC for USMS Inc. EVENTS:
More informationPromoters hosting USECF insured events must complete the included USECF event agreement and return to the USECF.
Dear Race Director, Thank you for your interest in using the USECF event coverage for your event. Enclosed you will find USECF insurance information for the 2017 year which can be used for gravel grinders,
More informationRegistration Form. Special Information (allergies, medical, behavioral, etc) you would like us to know about the gymnast/dancer:
Registration Form Gymnast/Dancer Information Name: Date of Birth (MM/DD/YYYY): School (For Scheduling Purposes): School District (For Scheduling Purposes): Special Information (allergies, medical, behavioral,
More informationSt. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01)
St. Cloud Steelhead Rugby Club Registration Check List 2011 (SCRF01) Please make checks payable to St. Cloud Rugby Steelhead Player Full Name: Shorts Size needed (circle one, shorts are men s sizes): Small
More informationColorado Trek Paper Work Check List
Colorado Trek Paper Work Check List Please make sure you have all your paperwork before sending it in Due June 2 - Paperwork Due June 2 - Full payment of $2400 NAME HATS Release Form Adventure Experience
More informationDeerfield Beach Surf Camp 2018 Registration Form
Deerfield Beach Surf Camp 2018 Registration Form For camp information call 954-281-2797 or go to www.islandcamps.com Camper s name DOB Parent/Guardian Name Address City State Zip Email: Phone (C) Phone
More informationEvent Registration Form
Event Registration Form Event and Date: Rider s Name: Rider s Address: Rider s Cell Phone: Rider s Age: Horse s Name: What level is your horse currently training: If you will be riding in the Fix-A-Test
More informationBetsy Owens Memorial Lake Swims
14 th Annual Betsy Owens Memorial Lake Swims One Mile and Two Miles Mirror Lake in Lake Placid, New York Saturday, August 15, 2015 Sponsored by: Adirondack LMSC & North Elba Park District Sanctioned by:
More informationPersonal Finance Summer Institute for College Readiness Application Instructions:
Personal Finance Summer Institute for College Readiness Application Instructions: Complete all fields in the Summer Institute Application (pages 2-6), print, and sign. Please print clearly or type. Make
More informationMEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM
MEDICAL INFORMATION AND MEDICAL TREATMENT RELEASE AND AUTHORIZATION FORM Camp Information Address: City, State, Zip Code: Gender: Medical Information The decision whether to permit the participant identified
More informationINSURANCE INFORMATION
These forms must be completed and signed in all appropriate places by the participant, the participant s physician, and if under age 18, by the participant s legal guardian. The medical information we
More informationNeumann University Informed Consent and Medical Release Form
Neumann University Informed Consent and Medical Release Form Name SSN DOB Year Sport Address: Emergency Contact: Name and Phone Number: Medical Insurance Company: Medical Insurance Policy Number: Medical
More informationUNITED STATES AUTO CLUB
UNITED STATES AUTO CLUB 2015.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
More informationGrand Island Central Catholic Shooting Team
Letter Program Requirements Signed Parental Consent Form. Signed Code of Conduct Form (Student & Parent / Guardian). Be enrolled At GICC during the time of participation. Follow & Live The "Code of Conduct".
More informationVolunteer Application
Volunteer Application Circle one: Ms. Mrs. Mr. Dr. Last: First: MI: Street Apt # City: State: Zip: Social Security: DOB Month: Day: Year: Age: Gender: male / female Organization Name: (if volunteering
More information*** ALL handlers/riders/drivers MUST complete this form *** CONDITIONS OF ENTRY AHSA LIABILITY DECLARATION EVERY HANDLER, RIDER, DRIVER, GROOM & ANYONE HANDLING A HORSE OR PONY MUST COMPLETE THE ARABIAN
More informationTULANE UNIVERSITY ATHLETICS CAMPS Physical Examination Information. Date / / Name of Camp: Name of Participant: Age: Birth date: / /
Physical Examination Information Date / / Name of Camp: Name of Participant: Age: Birth date: / / Each participant must EITHER attach a copy of a physician conducted sports examination applicable to this
More informationRedwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado (970) LLAMA LEASE AGREEMENT
Redwood Llama Company, LLC 1708 Greene Street PO Box 562 Silverton, Colorado 81344 (970) 560-2926 No. LLAMA LEASE AGREEMENT Redwood Llama Company, LLC ( Lessor ) agrees to lease to the Customer named below
More informationMEMBERSHIP APPLICATION WE RE A CAUSE WE RE MORE THAN A GYM. YMCA of Broome County
MEMBERSHIP APPLICATION WE RE MORE THAN A GYM WE RE A CAUSE YMCA of Broome County MEMBERSHIP RATES Membership Type Monthly Payment Annual Payment (automatic withdrawal) First payment will be pro-rated based
More informationRELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS
RELEASE OF LIABILITY, PROMISE NOT TO SUE, ASSUMPTION OF RISK AND AGREEMENT TO PAY CLAIMS Activity: CSU, Chico Recreational Sports Youth Camps Activity Date(s) and Time(s): Summer 2018 (June 11 August 10,
More informationCan-Am X-Team Racer Support Program Application Form PLEASE PRINT CLEARLY. INCOMPLETE OR ILLEGIBLE FORMS WILL DELAY PROCESSING.
Supporting Dealer Identification BRP Dealer # : Dealership Name : Dealership Fax Number : Dealer Contact : Email : Phone number : Racer Identification You must have had some racing experience in the past
More informationInformation about membership -
MEMBERSHIP INFORMATION 2018 We are excited about ST. CROIX JOAD and the opportunities that will present themselves to youth archers ages 8-20. ST. CROIX JOAD is one of only a handful USA ARCHERY JOAD clubs
More informationRelease of Liability PLEASE DO NOT CHANGE OR ALTER THE WORDING ON THIS WAIVER WITHOUT PRIOR APPROVAL FROM USROWING.
Release of Liability IN CONSIDERATION of being given the opportunity to participate in any USRowing activity, including scheduled, supervised club activities, and registered regattas, during the policy
More informationRELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT
RELEASE & WAIVER of LIABILITY INDEMNITY AGREEMENTS and MEMBERSHIP BEHAVIOR STATEMENT Available with permission from YMCA Services Corporation Copyright 2005 YMCA Services Corporation All Rights Reserved
More informationUNITED STATES AUTO CLUB
UNITED STATES AUTO CLUB 2016.25 MIDGET FAMILY COMPETITION LICENSE APPLICATION FOR ANNUAL FAMILY MEMBERSHIP & AUTHORIZATION FOR PUBLICITY USEAGE ANNUAL RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK
More informationCentral Plains Dressage Society Dressage Schooling Show at Oklahoma State Fair State Fair Park, Oklahoma City OK
Central Plains Dressage Society Dressage Schooling Show at Oklahoma State Fair State Fair Park, Oklahoma City OK Featuring Dressage and Western Dressage Excellent facility and footing Monday, September
More informationWaiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement
Name: Waiver, Release of Liability, Assumption of Risk, Indemnification, and Participation Agreement I, the undersigned individual, desire to use the U ROCK ( U ROCK s.a.l.) facilities located at Rebound
More informationHolster Qualification
SafeFire has approved a Draw and Shoot From the Holster certification. As always, safety is of paramount concern and even though the easy road would be to just say no, we are excited to offer this opportunity
More informationD.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet
D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team
More informationDAY CAMP 2018 REGISTRATION FORM
DAY CAMP 2018 REGISTRATION FORM PARTICIPANT INFORMATION FIRST NAME M.I. LAST NAME D.O.B. GENDER Male Female PARENT / GUARDIAN INFORMATION FIRST NAME M.I. LAST NAME D.O.B. GENDER Male Female STREET ADDRESS
More informationSouth Suburban Youth Rugby Club
South Suburban Youth Rugby Club Middle School Grades 4-8 High School Fresh-Soph & Varsity Registration for 2016 Spring Season ALL FORMS MUST BE COMPLETED AND TURNED IN AND DUES PAID IN FULL BEFORE A PLAYER
More informationSchedule: When: Saturday, December Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete
When: Saturday, December 9. 2017 Time: 9:00-4:00pm Where: Garrett s Sports Complex/Fieldhouse Cost: $60/ per athlete Instructors: SU Coaches & current SU Athletes Schedule: 9:00-9:45 Registration 9:45
More informationPersonal Finance Summer Institute Application Instructions: Read all instructions carefully, incomplete applications will not be considered.
Application Instructions: Read all instructions carefully, incomplete applications will not be considered. The 2017 will be June 26 June 30. Complete all fields in the Summer Institute Application. Print
More informationATHENS YMCA CAMP KELLEY SUMMER CAMP 2018
ATHENS YMCA CAMP KELLEY SUMMER CAMP 2018 POLICIES Cost: Full Week (5 Days) $115, Half Week (3 Days) $70; Additional Children: Any additional children will receive a $10 discount on full weeks ONLY. Registration
More informationBlue Chip BOTT Event Agreement and Waiver
Blue Chip BOTT Event Agreement and Waiver BLUE CHIP AGREEMENT AND LIABILITY WAIVER (this "Agreement and Waiver") PLEASE READ THE FOLLOWING AGREEMENT CAREFULLY, AS IT AFFECTS YOUR FUTURE LEGAL RIGHTS. BY
More informationSUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM
SUMMER YOUTH PROGRAMS 2018 PARTICIPATION INFORMATION FORM Personal Information Child s Name Age of Birth Parent/Legal Guardian 1 Phone Parent/Legal Guardian 2 Phone Address Alternate Phone work cell other
More informationTHE 2019 CAROLINA CLASSIC AT TRYON INTERNATIONAL EQUESTRIAN CENTER CRI 3*, CRIJ3* & CRIYR3* ENTRY FORM
THE 2019 CAROLINA CLASSIC AT CRI 3*, CRIJ3* & CRIYR3* ENTRY FORM May 9-12 Tryon, NC DUE MAY 8, 2019 For Office Use: # Horse Name: FEI #: Sire: Dam: Breed: Year Foaled: Sex (circle one): Stallion Mare Gelding
More informationNON-COMPETITION AGREEMENT
NON-COMPETITION AGREEMENT During the term of this Agreement, the Employee shall not directly or indirectly, either as an employee, employer, consultant, agent, principal, partner, stockholder, corporate
More informationWRAP/YMCA Expanded Learning Program
2018-2019 School Year School: Child s Last Name: First Name: Sex: M F Birth date: / / Age: Home Phone: ( ) Home Address: Cell Phone: ( ) City: State: Zip: Child lives with: Mom Dad Both Parents Other Begin
More informationEMERGENCY CONTACT INFORMATION. Name of person to contact in the event of an emergency;
BATTLE CREEK AREA HABITAT FOR HUMANITY WOMEN BUILD MAY 5, 9-12, 2018 (Battle Creek) MAY 17-19, 2018 (Marshall) VOLUNTEER APPLICATION (Please return via email, fax or mail) Name: (please print) Maiden Name:
More informationSouthern Swing Camps SIGN UP TODAY!!!
www.southernswing-volleyball.com Welcome from Southern Swing The Southern Swing Volleyball Camp strives to provide all its campers an opportunity to BE BETTER! Whether you are a beginner, intermediate,
More informationPARTICIPANT AGREEMENT (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
EXHIBIT D PLEASE READ CAREFULLY (For Adult Participants) RELEASE OF LIABILITY, VOLUNTARY ASSUMPTION OF RISK AND INDEMNITY AGREEMENT I,, a person being over the age of eighteen, hereby enter this RELEASE
More informationWAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS. As consideration for being allowed to participate in the event described below, I agree:
WAIVER, RELEASE OF ALL LIABILITY AND ASSIGNMENT OF CLAIMS As consideration for being allowed to participate in the event described below, I agree: 1. I acknowledge that motor vehicle activity is a potentially
More informationAmerican Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip
American Baptist Churches of Pennsylvania and Delaware January 30 - February 6, 2019 (Wednesday Wednesday) Haiti Mission Trip Part 1: Mission Trip Application: The total Cost is $1,175 $400 Deposit Due
More informationAPPLICATION FOR PART TIME EMPLOYMENT
APPLICATION FOR PART TIME EMPLOYMENT Position: Desired Hourly Rate: Last Name First Name Date Address Street City State Zip Code Phone Number Email Address Are you at least 18 years of age or older? Yes
More informationYouth Services Programs Application Please complete and return application to Nome Eskimo Community at 200 W. 5 th Avenue or Fax
P.O. Box 1090 Nome, Alaska 99762 Phone: (907) 443-2246 Fax: (907) 443-3539 www.necalaska.org Programs Application Please complete and return application to Nome Eskimo Community at 200 W. 5 th Avenue or
More informationYouth Camp REGISTRATION
Youth Camp REGISTRATION Parent #1 Name Home Phone Work Phone E-mail Address City State / ZIP Parent #2 Name Home Phone Work Phone E-mail Address City State / Zip 1. Camper s Name Age Gender Green and Gold
More informationLIMITATION OF LIABILITY
The Swiss Alps Natural Balance Retreat ( the Retreat ) (including Limitations of Liability, Release and Waiver of Liability, Hold Harmless, Covenant Not to Sue, Assumption of Risk and June 19-26 th, 2016
More informationRegistration Form. Mother s/guardian Name: LAST FIRST INITIAL Address: Home Phone: City: State: Zip: Cell Phone:
Registration Form Name: Address: City: State: Zip: School: Grade: Grad Year: GPA: HT: WT: Cell Phone: Email: Size: Shirt: Pants: Helmet: Shoe: Jersey #: (List 3 numbers) Parent/Guardian Information Player
More informationAFCC CAMPER REGISTRATION FORM
AFCC CAMPER REGISTRATION FORM Camper s Name Gender: M F Phone Number Email Address Address City/State/Zip Sponsor or Student Grade Completed (if student): Age Birthdate Church City T-Shirt Size: YM YL
More informationRaising Money for Autism
Raising Money for Autism Appendix I 1.) Release of Liability Form: 2.) Consent and Release of Guardian Form: 3.) Volunteer Sign Up Sheet 4.) Bowl-a-Thon Flyer In this section you will find all the forms
More informationPARADE APPLICATION RULES
PARADE APPLICATION RULES 1. All applicants for entry are subject to approval and acceptance by the Parade committee. For applications to be considered, they must be completed and received by December 1,
More informationApplication for Membership
Application for Membership The undersigned hereby applies for membership in THE HOUSTONIAN CLUB (the Club ), owned and operated by Houstonian Campus, LLC ( Owner ). Prior to acceptance for membership,
More informationNON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT
NON-EMPLOYEE ACTIVITY RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT Albright allows Participants to participate in Participant activities that may involve or require overnight
More informationInstructions for Completing Ford DSFL Waivers
Instructions for Completing Ford DSFL Waivers 1) Print out the four (4) forms attached. (Print in color if possible) 2) All 4 forms must be filled in COMPLETELY. If forms are not completed and signed properly
More informationWELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely
WELCOME TO KITTY HAWK KITES The Largest Hang Gliding School in the World - Where the Adventure Begins *please print clearly and fill out completely 1. Name: First Last M.I. 2. Email: 2. Mailing Address:
More informationSKATEBOARD COMPETITION ENTRY FORM
CITY OF KISSIMMEE PARKS, RECREATION & PUBLIC FACILITIES SKATEBOARD COMPETITION ENTRY FORM For your convenience, competition entry forms will be accepted in person, by mail, via fax or email at the location
More informationSport of Kings Challenge Warmup at Oklahoma State Fair Oklahoma City, OK Monday, September 17, 2018
Sport of Kings Challenge Warmup at Oklahoma State Fair Oklahoma City, OK Monday, September 17, 2018 Hunter, Jumper Excellent facility and footing 2 PM HJ Start Time Judge: TBA Entry Information: www.horseshowconsulting.com
More informationI. Appendix B - Summer Camp Release and NCAA Compliance Attestation
I. Appendix B - Summer Camp Release and NCAA Compliance Attestation For Participation in Activity in University Department of Athletics Facilities For the purposes of this document, herein after referred
More informationB.A.M. Brevard Attitude Modification
PLEASE PRINT Minor s Name: Age: Grade Entering: Date of Birth: Gender: (Male or Female) Address: City: Zip: Home Phone: Parent/Guardian Name: Place of Employment: Work Phone: Driver s License Number: Cell
More informationLake Washington Rowing Club
Lake Washington Rowing Club 2018 Junior Rowing Program Participant Information Form Participant Information (all fields must be filled out),, Last Name First Name Today s Date Mailing Address Birthdate
More informationCreate or join a team to bring this initiative to a hospital in your community
Dear Dance Fitness Instructor: Thank you for your participation in the Soaringwords initiative to provide free monthly dance-fitness classes at hospital facilities for the benefit of patients, families,
More information2013 USACA MEMBERSHIP & INSURANCE
2013 USACA MEMBERSHIP & INSURANCE USACA Membership and Insurance Dues for 2013 Membership and Insurance rates for 2013 will remain the same as 2012 rates Membership and Insurance (general liability and
More informationVENTURA COUNTY FAIR EXCA COWBOY CLASSIC
VENTURA COUNTY FAIR EXCA COWBOY CLASSIC Presents Event Date: August 10, 2017 Triple Point Race (1 Run) Multiple Division Entries Permitted Rider Name: EXCA Member #: Address: City / State / Zip: Telephone:
More informationAfter School Program Registration Form
2018-19 After School Program Registration Form Office Use Only Date registered: _ Staff: Please fill out this form entirely. If there are blanks it may slow down your child s enrollment process. If a line
More informationSCCA Rally/Solo Release and Waiver Guidelines
RISK MANAGEMENT I. Introduction SCCA Rally/Solo Release and Waiver Guidelines These guidelines are intended to provide basic information regarding release and waiver procedures for ALL non-club or SCCA
More informationVolunteer Information Form & Health History Packet
Volunteer Information Form & Health History Packet General Information Name: Age (If under 21): Address: City: State: Zip: Date of Birth: / / Home Phone# Cell Phone # Email: Occupation: Employer/School
More informationThe College of Wooster Checklist for Traveling
The College of Wooster Checklist for Traveling Send Student Organization Travel Itinerary to staff in Lowry Center and Student Activities one (1) week prior to departure. Send Organization Travel Roster
More information2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS
2015 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More information2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS
2016 AAU/USA NATIONAL KARATE CHAMPIONSHIPS CLUB APPLICATION INSTRUCTIONS 1. Any AAU member club may send in a club application, instead of individual entry applications. 2. Please follow all instructions
More informationSession I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church
th Session I and Session II Session I: June 5 June 9, Performance June 10th; Hollydale United Methodist Church Session II: June 12th - June 16th, Performance June 13th; Music On Wheels Academy Music Camp
More informationForm 2017 Open &Youth Llama/Alpaca. Entry Application
Open & Youth Llama/Alpaca Entry Application Order No. (Office Use Only) ENTRY DEADLINE February 5, 2017 LATE ENTRY February 15, 2017 PAYEE INFORMATION (Please type or print) ALL PROCEEDS UNDER THIS ENTRY
More informationNSU PREVIEW DAY. Wednesday, March 28, :00 a.m. 6:00 p.m.
PREVIEW DAY NSU Multimedia Camp Wednesday, March 28, 2018 8:00 a.m. 6:00 p.m. Parent/Guardian Contact Information Release and Waiver of Liability, Assumption of Risk and Indemnity Agreement Photo Release
More informationMedical Release Form/Media Release Form
Medical Release Form/Media Release Form All participants in TCS events must have a signed Waiver & Release Form, including adults 19 years and older. Participants under 19 must have the authorized signature
More informationWesthollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability
Westhollow Village Homeowners Association, Inc. Swimming Pool Use Acknowledge of Risk Waiver and Release of Liability In consideration of my use of Westhollow Village s swimming pools, I hereby forever
More informationCardiothoracic Surgical Skills and Education Center 2015 Stanford Summer Internship
2015 Stanford Summer Internship PROGRAM DATES: Program 1: June 22, 2015 to July 17, 2015 Program 2: July 20, 2015 to August 14, 2015 APPLICATION DEADLINE: February 13, 2015 Please (1) fill out the form
More informationMEMBERSHIP AGREEMENT
MEMBERSHIP AGREEMENT Applicant understands and agrees that the General Terms and Conditions of Membership are a part of this agreement. Enrollment Date: Member Name: Initiation Fees: Club Name: Membership
More informationParticipant Information (Incomplete information will not be processed) Last Name First Name Male Female Date of Birth: / /
ENTRY FORM Sponsored by Denver Northside Table Tennis 1-Star Tournament Sanctioned by USATT with $ 300 in Cash and Prizes Saturday, March 24 th 2018 www.denvernorthsidett.com or 303-601-3415 Participant
More informationASTROS RBI FORMS CHECKLIST PARTICIPANT NAME: PARTICIPANT DATE OF BIRTH: / / CONTACT PHONE NUMBER: CONTACT
-ALLTRYOUTSAT URBAN YOUTH ACADEMY 2801S.Vi ct orydr. ;Hous t on,tx 77088 PREREGI STER ONLI NEAT: ASTROS. COM/ UYA FOR OFFICE USE ONLY DIVISION: SOFTBALL JUNIOR SENIOR TRYOUT NO. ASTROS RBI FORMS CHECKLIST
More informationSt. Augustine Amphitheatre Farmer s Market. Vendor Application Instructions
St. Augustine Amphitheatre Farmer s Market Vendor Application Instructions To be considered for participation in the St. Augustine Amphitheatre Farmer s Market, please submit: - Completed and signed Vendor
More informationACADEMY DISTRICT 20 HIGH TRAILS PERMISSION FORM
ACADEMY DISTRICT 20 HIGH TRAILS PERMISSION FORM Team Name: Middle School: Student Name: Destination: High Trails Date of Trip: Departure Time: Return Time: Mode of Transportation: ASD20 Bus Departure Location:
More information2017/18 Out of School Program Registration Form
2017/18 Out of School Program Registration Form Child: First Name MI Last Name YMCA Member Non Member E-mail NOTE: There is a one time, non-refundable $20 registration fee per child required to secure
More informationASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT
ASSANTE DIRTY DASH FOR REBOUND - 5K MUD RUN RELEASE OF LIABILITY, WAIVER OF CLAIMS AND ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT Participant s Name: Age: Date of Birth : (M) (D) (Y) Address: City: Province:
More informationCorynna s Wish. Application for Corynna s Wish. Here Are the Requests We Are Unable to Grant. Eligibility Requirements for Recipients
Corynna s Wish Corynna s Wish is a nonprofit granting entity that is dedicated to fulfilling wishes that patients and their families cannot accomplish either physically or financially. The organization
More informationCamp Medical Information & Release Form
Global Youth Ministry Global Youth Camps 40 Blackhawk Trail Chatsworth, GA 30705 877-251-1800 www.globalyouthministry.org Camp Medical Information & Release Form Name Gender Age Birthdate / / Church/Org
More informationCITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR
CITY OF PALM COAST YOUTH PARKS & RECREATION DEPARTMENT ADULT REGISTRATION FORM SENIOR Please print clearly. Completion of the registration process is required for each participant prior to program start
More informationAthletics Participation and Pre-Participation Head Injury/Concussion Reporting Form
Athletics Participation and Pre-Participation Head Injury/Concussion Reporting Form Fall Athletics, 2018 The Parent(s)/Guardian(s) must fill in all blanks. Please print clearly. Athlete s Name: Date of
More informationARCHERY MEMBER AGREEMENT
4990 Ronald Reagan Blvd. Johnstown, Colorado 80534 l P: 970-578-0717 l F: 970-578-0722 l www.libertyrange.com ARCHERY MEMBER AGREEMENT Welcome and thank you for choosing to be a Member of Liberty Firearms
More informationPlease complete the following paperwork and return it to us in one of the following ways:
Thank you for your interest in volunteering with us! We are GRATEFUL for every hour that every volunteer serves. Whether your interest is in seeing patients in our HOPE Program, assisting with administrative
More information