Loading...

RANGE USE AGREEMENT

129 Pleasant Avenue

Absecon, New Jersey 08201

(609) 380-2557

Upon entering Range 129, I understand that I am entering a private shooting range at my own risk where I will encounter high levels of noise and the discharge of ammunition from firearms. By entering this property, it is at my own risk and I acknowledge the liabilities and dangers that exist in my use of any and all firearms and my participation in shooting activities.

 

First, I acknowledge and understand that shooting activities are inherently hazardous 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 and I assume the risks that could result in physical and/ or emotional injury, paralysis, death, or damage to myself, to property, or to third-parties. The risks include, but are not limited to; flying bullets, flying debris, noise, 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.

 

Second, I understand that Range 129 reserves the right to eject from the premises any individual who violates any of the rules of Range 129 or otherwise acts in any unsafe manner as determined by Range 129. The undersigned agrees to peaceably leave the premises of Range 129 if so ejected, after paying for all services and any damage that I may have caused to Range 129 property.

 

Third, in consideration of the acceptance of my participation , directly or as a spectator or observer, in any activity, class, competition, firing range rental, firearm rental, or other use of the facilities of Range 129, collectively hereinafter referred to as; "Activity", THE UNDERSIGNED AGREES TO ASSUME THE RISKS incidental to such participation and, on my own behalf and on behalf of my heirs, executors and administrators, I RELEASE, INDEMNIFY, DEFEND, HOLD HARMLESS, COVENANT NOT TO SUE AND FOREVER DISCHARGE Range 129 and related, affiliated and subsidiary companies, and the officers, directors, employees, volunteers, agents, representatives, insurers, successors, heirs and assigns of each, of and from fault, liabilities, costs, expenses,claims or demands for damages, causes of action, attachments of property, injury, death or financial compensation of any nature arising out of or in any way connected with my participation in any such Activity.

 

Fourth, I also Release, Indemnify, Defend, Hold Harmless and Forever Discharge Range 129 from all lawsuits arising out of, related to or connected with: the discharge of firearms; the course of instruction, the Range 129 range, buildings, land and premises (hereinafter the "premises") and my presence on or use of said premises. And, should any such claim, demand or lawsuit arise or be asserted in any way whatsoever related thereto, whether arising under the laws of the United States, the State of New Jersey, or under any theory or law or equity, I will Indemnify, Defend and Hold Harmless Range 129 from any and all costs, expenses, or liability including, but not limited to, the cost of any settlement or judgment made or rendered against Range 129, whether individually, jointly or in solidarity with the undersigned, together with all costs and other costs or expenses incurred in connection with any such claim, demand or lawsuit including attorney's fees.

 

Fifth, I acknowledge and understand that Range 129 makes no warranty as to the design, manufacture, maintenance, condition or fitness for any particular purpose of any range facilities or equipment, including, but not limited to; firearms, ammunition, eye/hearing protection and first-aid supplies. I agree to assume any and all responsibility and liability for any act or acts, even any negligent, reckless or criminal act or omission to act, of my guests at the range and for minors under my supervision. Also, I agree to supervise and be responsible for any minor in my care while on the property and I shall be personally responsible for my safety and the safety of minors under my supervision and for the safety of my guests.

 

Sixth, I waive for myself and my executors, administrators, assignees or heirs, any and all rights and claims for damages, losses, demands and any other actions whatsoever, which I may have or which may arise against Range 129, including but not limited to any and all injuries, damages or illnesses suffered by me or my property, which may, in any way whatsoever, arise out of, be related to or be connected with;

1.  the course of instruction;

2.  the premises, including any latent defense in the premises;

3.  my presence on or use of said premises;

4.  my property, whether or not entrusted to Range 129 and;

5.  the discharge of firearms.

Range 129 shall not be liable for, and I hereby expressly Release, Indemnify, Defend and Hold Harmless Range 129 from any and all such claims on behalf of myself and my executors, administrators, assignees, or heirs.

 

Seventh, I acknowledge and understand that Range 129 has no duty to undertake first-aid or rescue operations or procedures in the event any such property damage or physical or emotional injury occurs. In entering into this Agreement, I hereby grant Range 129 a Limited Power of Attorney and authorization to obtain, at my cost, any and all emergency medical treatment, which may be needed by me as a result of participation in any Activity. For the purposes of this Agreement, emergency medical treatment means medical care or treatment necessitated by a sudden, unexpected situation demanding immediate medical attention . However, I Release, Indemnify, Defend, Hold Harmless, Covenant not to Sue, and Forever Discharge Range 129 of and from all liabilities, claims, actions, damages, costs or expenses of any nature arising out of or in any way connected with the exercise or the failure to exercise such Limited Power of Attorney and authorization, whether negligent or otherwise.

 

I expressly agree that this Agreement is intended to be as broad and inclusive as permitted by law, and that if any provision of this Agreement is held illegal, invalid or otherwise unenforceable, the enforceability of the remaining provisions shall not be impaired thereby, and such invalid part, term or provision shall not be deemed part of this Agreement. Further, I agree that any ambiguities in this Agreement shall not be construed in favor or against any party by virtue of that party having drafted the Agreement. No remedy conferred by any of the specific provisions of this Agreement 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 shall not constitute any waiver of the right to pursue other available remedies.

 

I certify that I am entering into this Agreement on my own behalf. I expressly understand that the aforementioned Activity includes the discharge of firearms and the firing of live ammunition. I further certify that I have completely read the foregoing and I expressly agree.

 

I have read, agree and understand the Range 129 Range Rules and this liability waiver and I was given the opportunity to ask for clarification of any of the rules before signing this Agreement.

December 6, 2019

 

First Customer's Name

First Name*

Middle Name

Last Name*

Phone*
First Customer's Date of Birth*
First Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
First Customer's Signature*
Second Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Second Customer's Date of Birth*
Second Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Third Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Third Customer's Date of Birth*
Third Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Fourth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Customer's Date of Birth*
Fourth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Fifth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Customer's Date of Birth*
Fifth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Sixth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Customer's Date of Birth*
Sixth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Seventh Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Customer's Date of Birth*
Seventh Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Eighth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Customer's Date of Birth*
Eighth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Ninth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Customer's Date of Birth*
Ninth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Tenth Customer's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Customer's Date of Birth*
Tenth Customer's Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
Customer'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*
Do you possess a New Jersey Firearms ID Card?
No
Yes

If Yes, please enter your Firearms ID Card Number
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 Questionnaire
Are you a convicted felon?*
No
Yes
Are you currently on probation?*
No
Yes
Are you under the influence of alcohol, chemical substances or controlled substances?*
No
Yes
Are you suicidal or depressed or are you receiving treatment or taking medication for depression?*
No
Yes
Have you been issues a restraining order due to committing acts of domestic violence?*
No
Yes
Have you ever been adjudged mentally incompetent?*
No
Yes
Have you ever handled a handgun, rifle or shotgun?*
No
Yes
If so, which one?
Handgun
Rifle
Shotgun
Please select the answer that best describes your shooting experience;*
New Shooter
1-2 Times a Year
1-2 Times a Month
1-2 Times a Week
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver