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KMA Student Archer Information Sheet and Waiver

SAFETY NOTICE:

When safety rules are not followed archery can be dangerous. Although injuries are rare they can still happen. If you wish to participate in this archery program you must be aware of the dangers of a shooting sport. Shooting archery is a fun activity and, at this club, will be conducted under the close supervision of a National Field Archery Association certified instructor who will try to minimize all possible dangers.

Previous archery experience

Have you ever used archery equipment?

Have you taken other formal archery classes?

If you have taken archery before, what do you hope to accomplish during this session?

PERMISSION TO TOUCH: CONSENT/DENIAL

In order to demonstrate or to show you how to accomplish the proper bow arm position, stance, back tension, etc., sometimes the instructor may need to touch your head, neck, shoulders, arms, hands, back, trunk, hips, legs and feet to help you get into the proper position.

Do you CONSENT to being touched?

Yes

In compliance with current insurance requirements your signature at the end of this form indicates you have read, understand and agree to the conditions on the BACKSIDE of this form – ATTACHED OR NOT.

Instructor’s Signature

Note: Information gathered on this form is retained locally for statistical and record keeping purposes and may also be forwarded to the National Field Archery Association as proof of course participation. No other use of this information is permitted. Your name and information will not be sold nor transferred to third parties for the purposes of marketing. For this reason your street address is not requested.

ARCHERY CLUB WAIVER AND RELEASE OF LIABILITY READ BEFORE SIGNING

In consideration of being allowed to participate in any way in Kings Mountain Archers (“KMA” or the “club”) events and activities, the undersigned acknowledges, appreciates, and agrees that:

1) The risk of injury from archery and participation in any other club activity or participation in any activity on club premises can be significant, including the potential for permanent paralysis and death, and while particular rules, equipment and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2) I acknowledge and agree that the use of archery equipment and other weapons by myself or others on club premises or otherwise are inherently dangerous and high risk activities, whether such archery equipment, or weapons are discharged by myself or others; and

3) I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASEES or others, and assume full responsibility for my participation; and

4) I willingly agree to comply with the stated and customary terms and conditions for participation. If, however, I observe any unusual significant hazard during my presence or participation, I will remove myself from participation and bring such to the attention of the nearest club official immediately; and

5) I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS Kings Mountain Archers, its officers, directors, officials, agents, employees, volunteers, members, guests, other participants, sponsoring agencies, sponsors, advertisers and, if applicable, owners and lessors of real property and personal property used to conduct club events and activities (“RELEASEES”), WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

FOR PARTICIPANTS OF MINORITY AGE
(UNDER AGE 18 AT THE TIME OF PARTICIPATION)

This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her participation in club activities and release as provided above of all the Releasees, and for myself, my heirs, assigns, and next of kin. I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my minor child’s involvement or participation in these events and activities and/or the use of related real and personal property as provided above, EVEN IF ARISING FROM THEIR NEGLIGENCEOF THE RELEASES.

Name of minor(s)

Parent/Guardian Signature Emergency phone number Date Signed

Release for photo and video use by KMA

I also give permission and release for use of any photo or video likeness occurring from participation in club activities or events for the purpose of promoting club activities and events. This release is for the adult participant(s) and any minor(s) listed on this form. All adult participants or household members must sign below.

Adult participant’s signature(s).

Leave this empty:

Your legal name

Your email address

Please Confirm full name and signature.

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Timestamp

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March 22, 2018 5:05 pm PDT

KMA Student Archer Information Sheet and Waiver Uploaded by Gary Johnston - membership@kingsmountainarchers.org IP 73.231.206.127

April 10, 2018 5:27 pm PDT

Lessons Coordinator - lessons@kinsgmountainarchers.com added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127

April 10, 2018 5:28 pm PDT

Lessons Coordinator - lessons@kinsgmountainarchers.com added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127

April 10, 2018 5:37 pm PDT

Lessons Coordinator - lessons@kinsgmountainarchers.org added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127

April 10, 2018 5:47 pm PDT

Lessons Coordinator - lessons@kingsmountainarchers.org added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127

May 1, 2018 5:05 pm PDT

Lessons Coordinator - lessons@kingsmountainarchers.org added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127

May 1, 2018 5:33 pm PDT

Lessons Coordinator - lessons@kingsmountainarchers.org added by Gary Johnston - membership@kingsmountainarchers.org as a CC'd Recipient Ip: 73.231.206.127