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Risk Acknowledgement, Release & Indemnity Agreement

 

All information supplied will be kept strictly confidential, not distributed or made available to others for any purpose, and is for the sole use by Range America to properly identify the user, document their previous firearms experience. This is being done to best ensure the safety of all range users.  Everyone who wishes to shoot in this facility, whether using their own or a Range America rental firearm MUST sign and agree to all terms in this Smartwaiver form.

ANYONE SUSPECTED OF ALCOHOL OR DRUG USE WILL NOT BE ALLOWED ON THE RANGE.

Firearms Safety

1. Treat all firearms as if they are loaded

I Agree

2.  Keep firearms pointed in a safe direction.  At  Range America the only safe direction is down-range away from other customers.

I Agree

3.  Keep the firearm on safe until you are ready to shoot.

I Agree

4.  Keep your finger off the trigger until you have acquired your sights and are ready to shoot.

I Agree

 

There is NO steel case/steel cored rifle ammuntion allowed at Range America.

I Agree

 

Firearms handling is strickly prohibited outside of the shooting stalls.  Ensure that you fully enter the stall, verify that the firearm is pointed in a safe direction and remove the firearm ftom its bag, case, or holster.

When you have completed your shooting ensure that you verify your firearms are unloaded and all safety's are properly engaged.  Upon completion of firearms clearing, bring your bag, case, or holster in to the

shooting stall to store your firearm.

I Agree

 

Shooters will be held liable for damage to the range. regardless of intent.  If you have any questions about the facility, safety, or the firearms you are using, Range Safety Officers are on the range to help you.

Please do not hesitate to ask for help.  By initializing below you are stating that you have read the safety rules and agree to abide by them.  The RSO has the authority to remove anyone deemed unsafe or 

believed to be under the influence of alcohol or drugs.

Todays date: November 22, 2019

I hereby acknowledge that I have voluntarily applied to enter on to and to engage in or to observe shooting and other activities at Range America (the "RANGE").  I further acknowledge and understand

that "shooting and other activites" includes any and all activities of any kind whatsoever in which I engage or observe while at the RANGE, whether sponsored by Range America or not. [inital]

 

I ACKNOWLEDGE AND UNDERSTAND THAT SHOOTING ACTIVITIES ARE INHERENTLY DANGEROUS  and involve both known and unanticipated risks which could result in damage or destruction of

property and physical or emotional injury, including paralysis or death, of myself or of other persons. The risks include, but are not limited to: being shot by or shooting myself or others; partial or total loss of

eyesight or hearing; inhalation or other harmful contact with lead or other contaminants; and being struck by flying or falling objects.  I understand that such risks cannot be eliminated without compromising the

essential qualities of shooting activities.

I Agree

I FURTHER ACKNOWLEDGE AND UNDERSTAND THAT the nature and condition of the RANGE Facilities, premises, and environment is such that both known and unanticipated hazards exist which create

or contribute to both known and unanticipated risks inherent in entering on to the RANGE, in usuin RANGE facilities an in engaging in or observing any activities of any kind whatsoever while at the RANGE.

The hazards include, but are not limited to: slipping, falling, inhalation of contaminants, contact with hot brass, lead, and other metals, contact with flying brass, lead, and other metals, falling ceiling tiles,

falling baffles, falling shooting trays, and falling shooting stalls.  I understand that such hazards and risks cannot be eliminated without compromising the essential qualities of the RANGE facilities, 

equipment, premises, and environment.

I Agree

 

 

RENTAL FIREARM AGREEMENT TERMS 

 

ALL AMMO USED IN OUR RENTAL FIREARMS MUST BE PURCHASED FROM RANGE AMERICA.

You must be 21 years old with a valid ID to rent a firearm.

Range America will retain your drivers license and credit/debit card to be returned when firearm is returned to the rental counter.

I Agree

 

As lawful consideration for being permitted by Range America to enter on to the RANGE, to use RANGE facilities or equipment and to engage in or observe shooting and other activities at the RANGE, as 

either a Member or a GUEST, I agree as follows:

I EXPRESSLY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS EXISTING ON THE RANGE AND IN ENTERING ON TO THE RANGE AND IN USING FANGE FACILITIES OR EQUIPMENT AND IN ENGAGING IN OR OBSERVING SHOOTING AND OTHER ACTIVITIES AT THE RANGE FOR MYSELF AND MY GUESTS.

I AGREE that I, my next of kin, heirs, guardians, representatives, and assigns HEREBY RELEASE AND FOREVER DISCHARGE AND AGREE NOT TO SUE RANGE AMERICA (I understand that

"RANGE AMERICA" includes any and all officers, directors, attorneys, agents, employees, contractors, volunteers, guests, and affiliated individuals or organizations of RANGE AMERICA)  from and against 

any and all claims, demands, damages, expenses, causes of action, attachments of porperty, or liability of any kind whatsoever, that I, my next of kin, or heirs, guardians, representatives or assigns may have for

property damage, personal injury or death resulting from me or my guests entering on to the RANGE, using RANGE facilities or equipment, or engagin in or observing shooting and other activities athe RANGE, even

if suchclaims, demands, damages, expenses, causees of action, attachements of property, or liability result partially or wholly from any act or acts, even any negligent act or omission to act, including negligent 

or omitted first-aid or rescue operations or procedures, by RANGE AMERICA.

I Agree

I ACKNOWLEDGE AND AGREE that this AGREEMENT shall be interpreted and enforced under the laws of the State of Kentucky, and that the venue for any action or proceeding shall be the State of Kentucky,

without regard for the conflict of law rules of the State of Kentucky.  I FURTHER ACKNOWLEDGE AND AGREE that this Agreement is intended to be as broad and inclusive as permitted by law, and that if any

provision or portion is held to be invalid, void or otherwise enforceable, I agree and intend that the remaining provisions and portion shall continue and remain in full legal force and effect.

I Agree

I FURTHER ACKNOWLEDGE AND AGREE that if I initiate litigation, a lawsuit, or court proceedings of any kind arising out of, sounding in, or related to, any activities covered by or mentioned in this Agreement,

I will pay Range America's attorney's fees, costs, and expenses resulting from such action.

I Agree

I FURTHER ACKNOWLEDGE AND AGREE that it is my understanding and intent that this Agreement, and any signed written amendments or modifications to it, shall remain in full force and effect from

the date of execution and ever after and shall be applicable to each and every occasion that I or my GUESTS enter on to the RANGE, use RANGE facilities or equipment or engage in or observe shooting

and other activities at the RANGE.

I Agree

I FURTHER ACKNOWLEDGE AND AGREE that I am not under indictment in any court for a FELONY, OR any other crime for which the judge could have sentenced me for more than a year in jail or prison,

nor have i been CONVICTED for a felony, nor a FUGITIVE from justice.  I am not using illegal drugs or controlled substances, nor have I been adjudicated mentally defective OR been commited to a mental 

institution.  FURTHER I have not been discharged from the Armed Forces under DISHONORABLE conditions, not subject to a court order restraining me from harrassing, stalking or threatening my child, or 

an intimate partner.I have not been convicted of domestic violence nor been DENIED while attempting to purchase a firearm.  Also, I know of no reason that I cannot legally possess a firearm under state or 

federal law.  FUTHER, I understand that if any of these conditions change in the future, it is my responsibility to notify the staff of Range America.

I Agree

I have carefully read this "Acknowledgement of Risk, Release & Indemnity Agreement" and fully know its contents.  I acknowledge that no other inducement, assurance, or guarantee has been made to me in 

consideration of my signing this Agreement, which I sign voluntarily and of my own free will. I further acknowledge and agree that this Agreement may be amended or modified only by a writing signed by me 

and by an authorized agent of RANGE AMERICA.

If i cause any damage to the RANGE AMERICA property, whether accidental, negligent, willful, or otherwise, I will be removed from the range and/or facility, and suspended or terminated from RANGE AMERICA.

The individual responsible for the damage may be civially liable or criminally prosecuted.  RANGE AMERICA reserves the right to charge me the costs of such damage.  Should court action be required to collect

the damages, I will also be liable for RANGE AMERICA attorney's fees.

I EXPRESSLY WARRANT THAT I HAVE READ EVERY WORD OF THIS AGREEMENT AND THAT I HAVE ENTERED INTO THE AGREEMENT OF MY OWN DESIRE.

I UNDERSTAND THAT BY MY SIGNATURE I AM GIVING UP SUBSTANTIAL RIGHTS, THAT I AM AGREEING NOT TO SUE RANGE AMERICA AND RELEASING AND HOLDING HARMLESS

RANGE AMERICA OF ALL LIABILITY FOR ACTS AND OMISSIONS COVERED BY THIS AGREEMENT.

Signed on  November 22, 2019 at Range America, 3021 Old Husbands Road, Paducah, KY 42003

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Second Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Third Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fourth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Fifth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Sixth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Seventh Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Eighth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Ninth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
No
Yes
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Tenth Participant's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
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*
Check to receive information, news, and discounts by email.
A signed copy of this waiver will be sent to the email address you provide.
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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
How would you rate your experience Level with a HANDGUN?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a RIFLE?*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
How would you rate your experience level with a SHOTGUN*
NOVICE
BEGINNER
INTERMEDIATE
EXPERT
Are you under indictment or any information in any court for a FELONY, or any other crime, for which the judgement could imprison you for more than one year?*
No
Yes
Are you an unlawful user of, or addicted to, marijuana, any depressant, stimulant, or narcotic drug, or any other controlled option*
No
Yes
Have you ever been adjudicated as mentally defective, been committed to a mental institution or have a history of mental illness?*
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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