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St Bernard Indoor Shooting Center

 

MEMBERSHIP APPLICATION / RANGE WAIVER

 

 

 

Everyone who wishes to shoot or train in this facility, whether using his or her own firearm, rental firearms or no firearm at all must COMPLETELY fill out this form. All information supplied will be kept strictly confidential, not distributed or made available to others for any purpose, and is for the sole use of The St Bernard Indoor Shooting Center (STBISC) to properly identify the user. This is being done to ensure the safety of all range users.

 

ACKNOWLEDGMENT OF RISK

I understand that the use of firearms, self-defense training, physical activity, and life in general, is a hazardous activity that can cause serious bodily injury and/or death. By signing below, I acknowledge that I accept that risk and that I am responsible and liable for my actions while using the STBISC range and at all times while on STBISC Property.

 

LIABILITY RELEASE:

Applicant, for itself, executors and assigns, releases the STBISC, 212 Aycock LLC, NOLATAC LLC and its Agents, Employees, Partners and Instructors from any and all liability for personal injury or property damage arising out of the use of the equipment or facilities of the STBISC.

Applicant agrees to hold the STBISC free, clear, and harmless and indemnify the STBISC, 212 Aycock LLC, NOLATAC LLC and its Agents, Employees, Partners and Instructors from any responsibility for any and all claims and demands for personal injury or property damage arising out of use of the facilities or equipment.

 

In consideration for my being permitted to participate in the activities of The St Bernard Indoor Shooting Center (STBISC) and NOLATAC Training and Consulting.

I acknowledge that shooting has inherent risk, hazards and dangers that cannot be completely eliminated.

I UNDERSTAND THAT THESE INCLUDE BUT ARE NOT LIMITED TO:

1. The risk of handling firearms and being near others that have firearms in their possession.

2. The risk of personal injury and / or damage to personal property from shooting events and physical activity.

3. The risk of personal injury from the physical requirements of shooting events.

4. The risk of possible ear damage from noise.

5. The risk of possible eye damage.

6. Exposure to lead dust and particles.

EYE AND EAR PROTECTION IS REQUIRED AT ALL EVENTS.

While STBISC does maintain shooting club liability coverage I understand that each range in which an event is conducted is responsible for maintaining liability insurance for that event. STBISC is not responsible for that coverage or verification of that coverage. Completion of a separate Waiver for each individual range is the responsibility of the range owner not STBISC. I further understand that I will be required to meet and abide by any rules or requirements of the host range as well as those set forth by STBISC.

I understand the risks, hazards, and dangers as described above and have had the opportunity to discuss any questions with an officer of STBISC. I understand that these activities may require good physical condition and a degree of skill and knowledge. I believe that I have the physical conditioning and degree of skill and knowledge needed for me to engage in these activities safely. I understand that I have responsibilities. My participation in this activity is purely voluntary. I am voluntarily using the services of STBISC with full knowledge of the inherent risks, hazards and dangers involved and hereby assume and accept any and all risks of injury, paralysis or death.

Last, I, for myself, my heirs, successors and executors, and subrogates, hereby and knowingly and intentionally waive and release, indemnify and hold harmless STBISC staff personnel, STBISC and all officers, partner companies and entities, agents, employees and volunteers from and against claims, actions, cause of action, liabilities, suites and expenses (including reasonable attorneys fees) which are related to, arise out of, or are in any way connected with any participation in any activity including, but not limited to, negligence of any kind in nature, whether foreseen or unforeseen, arising directly or indirectly out of any damage, loss, injury, paralysis, or death to me or my property as services, animals or equipment, whether such damage, loss, injury, paralysis, or death is a result of negligence of STBISC and course designs or from some other cause. I, for myself, my heirs, my successors, executors and subrogates, further agree not to sue STBISC, any officers or directors, agents, employees or volunteers as a result of any injury, paralysis or death suffered in connections with my use and participation in any activity connected with STBISC.

 

I have read and understand the Waiver and Release Agreement above and I understand that this Waiver and Release Agreement applies equally to any minor children in my home that I have listed as family members on this application.

 

 

Initial

Dated: August 16, 2018

 

VIOLATION OF ANY RULES OR POLICIES MAY RESULT IN THE LOSS OF RANGE PRIVILEGES AND REMOVAL FROM THE PREMISES WHEN DEEMED NECESSARY BY THE RANGE STAFF WITHOUT REFUND.

PLEASE READ & INITIAL EACH OF THE RANGE RULES, THEN SIGN AND DATE BELOW.

 

 

 

1. Eye and ear protection must be worn at all times while inside the range.

2. Drug and alcohol use is strictly prohibited. We will not allow anyone to shoot that we believe is under the influence of any drugs or alcohol.

3. No food or beverages are allowed in the range area.

4. NEVER cross the firing line or proceed in front of the shooting benches.

5. Personal firearms must be unloaded and cased, or holstered and concealed with current CHP. DO NOT EXPOSE ANY FIREARM IN THE STORE. If you walk in with a firearm holstered, it stays holstered until you are on the range and facing down range.

6. ALL FIREARMS MUST BE POINTED DOWN RANGE AT ALL TIMES and never pointed higher than the target.

7. DO NOT BRING A LOADED OR MALFUNCTIONING FIREARM OFF THE RANGE EVER! If there is a problem, lay the firearm on the bench, with the muzzle pointed down range, and notify staff.

8. FIREARMS MAY ONLY BE HANDLED IN SHOOTING STALLS . Do not load, unload, repair, or in anyway handle a firearm outside of the shooting stalls.

9. Only one person may fire from a shooting booth at a time. Do not exchange firearms with another booth. Please switch shooters between booths, never firearms between booths.

10. Brass may only be retrieved from behind the firing line and only the amount you brought into the range.

11. DO NOT throw brass in garbage cans. Please push brass forward when finished shooting.

12. All ammunition and firearms may be inspected by staff.

13. NO STEEL JACKET, STEEL CORE, TRACER, OR ARMOR PIERCING BULLETS ALLOWED. IF YOU ARE CAUGHT WITH STEEL, YOU WILL BE ASKED TO PERMANENTLY LEAVE.

14. Only STBISC ammunition is to be used in rental firearms. We do not allow outside ammo or reloads in our rental firearms.

15. Un-aimed or uncontrolled fire is strictly prohibited. All shots must be fired at approved targets. You are financially responsible for any damage that you cause to the facility. Failure to report such an incident will jeopardize your use of the facility and will result in civil and/or criminal legal action.

16. Anytime a cease fire is called, stop shooting immediately, place firearm on safe, place your firearm on the bench and back away from the firing line immediately. Any shooter is allowed to call a cease fire for any safety violation, anytime.

17. Shooters under the age of 18 must be supervised by a parent or guardian. Minimum shooting age is 12 years old without prior authorization from staff.

18. The STBISC employees have unquestionable authority regarding the operations of the range.

19. Members caught shooting steel ammunition will have their membership permanently canceled WITH NO REFUND (If you are not sure of your ammunition, please ask).

20. ANY UNSAFE ACT, as defined by range staff, will result in immediate removal and possible revocation of membership until further training is received.

21. The St Bernard Indoor Shooting Center is a training center that is open to the general public when not being used for training. That means that our focus is the training of individuals in the safe handling and use of firearms and other topics. As such, there are times when we will have to close the facility to the public, to include members, in order to facilitate our core purpose. We will of course try to keep those instances to a minimum, but reserve the right to close the range a maximum of one weekend per month (Fri-Sun) to support our visiting defensive instructors, as well as one day per week for private or VIP training. We will make all notifications of closures via our FaceBook page, online forum, and other electronic means. STBISC also reserves the right to change the terms and conditions of this membership including the benefits at anytime.

22. STAFF MEMBERS' DIRECTIONS MUST BE FOLLOWED AT ALL TIMES.

I HAVE READ AND UNDERSTAND THE SHOOTING RANGE RULES AND AGREE TO FOLLOW THEM AT ALL TIMES. BY SIGNING BELOW, I ACKNOWLEDGE THAT I ACCEPT THAT RISK AND THAT I AM RESPONSIBLE AND LIABLE FOR MY ACTIONS WHILE USING THE STBISCs RANGE.

 

Signature:

Dated: August 16, 2018

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Email

Email *
Race?*
White
Black
Asian
Native American
Hispanic
Other
Have you ever been adjudicated as mentally defective, been committed to a mental institution, having suicidal thoughts, or have a history of mental illness?*
No
Yes
Have you ever been convicted of a FELONY, VIOLENT MISDEMEANOR, or otherwise prohibited from handling or possessing firearms?*
No
Yes
Are you an unlawful user, or addicted to, marijuana, or any depressant, stimulant, or narcotic drug, or any other controlled substance?*
No
Yes
Have you consumed alcoholic beverages of any content, taken any illegal drugs, or taken any prescription drugs where it is recommended you not drive or operate heavy machinery within the last 8 hours?*
No
Yes

What training have you previously had with firearms? (law enforcement, military, private instruction, NRA class, ETC)
Are you a National Rifle Association member?*
No
Yes
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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