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Archery Range Waiver 

Brookings County Outdoor Adventure Center

 605.693.4622

info@bcoac.org

 

 

RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT

AND CONSENT TO MEDICAL TREATMENT

By my signature below, I acknowledge that I am aware of, appreciate the character of, and voluntarily assume the risks involved in participating in the activity listed below:

Shooting sports at the Brookings County Outdoor Adventure Center including, but not limited to, participating in events on the archery and pistol ranges.

By my signature below, on behalf of myself, my heirs, next of kin, successors in interest, assigns, personal representatives, and agents, I hereby:

Waive any claim or cause of action against and release from liability the County of Brookings, its officers, employees, volunteers, and agents for any liability for injuries to my person or property resulting from my participation in the activity listed above; 
Agree to indemnify and hold harmless Brookings County, its officers, employees, volunteers, agents, or assignees, from any loss, liability, damage, claim, or cost that may incur arising out of or related to the Undersigned’s injury or death, whether caused by the negligence of the County of Brookings or otherwise; 
Acknowledge that the activity listed above is very dangerous and involves the risk of serious injury and/or death and/or property damage.  The Undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or medical procedures of the County of Brookings, its officers, employees, volunteers and agents; 
Consent to receive any medical treatment deemed advisable during my participation in the activity listed above.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF THE RISK AND INDEMNITY AGREEMENT AND CONSENT TO MEDICAL TREATMENT, 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, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

I Agree

First Guests Name

First Name*

Last Name*

Phone*
First Guests Date of Birth*
First Guests Signature*
Second Guests Name

First Name*

Last Name*
Second Guests Date of Birth*
Third Guests Name

First Name*

Last Name*
Third Guests Date of Birth*
Fourth Guests Name

First Name*

Last Name*
Fourth Guests Date of Birth*
Fifth Guests Name

First Name*

Last Name*
Fifth Guests Date of Birth*
Sixth Guests Name

First Name*

Last Name*
Sixth Guests Date of Birth*
Seventh Guests Name

First Name*

Last Name*
Seventh Guests Date of Birth*
Eighth Guests Name

First Name*

Last Name*
Eighth Guests Date of Birth*
Ninth Guests Name

First Name*

Last Name*
Ninth Guests Date of Birth*
Tenth Guests Name

First Name*

Last Name*
Tenth Guests Date of Birth*
Parent or Guardian's Email Address

Email*

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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
I am the Parent or guardian who is under the age of 18 and legally is considered to be a minor. I have explained to them the above-aforementioned Agreement of Liability, Waiver and Assumption of Risk and I accept full responsibility for their behavior and am fully liable for their actions. (A separate form must be filled out for each child under the age of 18.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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