Loading...

WILSHIRE GUN, LLC RELEASE, WAIVER OF LIABILITY, INDEMNIFICATION, AND ARBITRATION AGREEMENT

PLEASE READ THIS AGREEMENT CAREFULLY BEFORE ACCEPTING.

This is a legally binding release, waiver of liability, indemnification agreement, and agreement to arbitrate, and contains an express assumption of risk!

It is recommended that you seek the advice of legal counsel.

I, the undersigned, hereby affirm that I have read this Release, Waiver of Liability, Indemnification, and Arbitration Agreement (“Release”) in its entirety. By agreeing to this Release, I agree to each and every term and condition hereof.

In consideration of, and as a condition precedent to, being permitted to be in, about or upon the premises and facilities of Wilshire Gun, LLC, an Oklahoma limited liability company (“Wilshire Gun”), located at 615 W. Wilshire Blvd., Suite 1400, Oklahoma City, OK 73116  for any purpose, including but not limited to, the discharge of firearms, shooting sports, target practice, quick-draw shooting, archery, self-defense training, first aid or emergency preparedness training, and paintball, airsoft, simunitions, and other simulated firearms activities, whether sponsored, hosted or instructed by any of the Wilshire Parties (defined below) or third parties (the “Activities”), I hereby agree to the terms and conditions set forth in this Release.

This Release is for the benefit of Wilshire Gun, and its respective affiliates, partners, managers, officers, members, employees, agents, attorneys, contractors, representatives, lessors, lessees, licensees, parents and subsidiaries (collectively, the “Wilshire Parties”).  This Release applies and covers all aspects of your presence in, about or upon the premises of any of the Wilshire Parties or all of them located at 615 W. Wilshire Blvd., Suite 1400, Oklahoma City, OK 73116, including, but not limited to, the parking lot, building, retail store, restaurant, and club (collectively, the “Premises”), and includes without limitation your presence in, or use of, the shooting facilities located in and on the Premises, and the use of or presence in or around the firearms and equipment of any of the Wilshire Parties or all of them (collectively, the “Facilities”) and participation in, presence at, or observance of any Activities or other events.

I understand and acknowledge that the Activities include rapid semi-automatic fire, full-automatic fire, and quick-draw shooting, sometimes called fast shooting, which involves drawing a firearm from a holster, and that these type of shooting are considered some the of most hazardous firearms activities to not only the shooter, but to all persons in or around the facility. 

  1. ASSUMPTION OF RISK. BY EXECUTING THIS RELEASE, I ACKNOWLEDGE AND AGREE THAT THE ACTIVITIES ARE INHERENTLY HAZARDOUS AND INVOLVE BOTH KNOWN, UNKNOWN, ANTICIPATED, AND UNANTICIPATED RISKS WHICH COULD RESULT IN DAMAGE OR DESTRUCTION OF PROPERTY AND SERIOUS PHYSICAL, PSYCHOLOGICAL OR EMOTIONAL INJURY, INCLUDING BUT NOT LIMITED TO PERMANENT DISABILITY, PARALYSIS OR DEATH, TO MYSELF OR OTHER PERSONS, INCLUDING FURTHER INJURY OR DAMAGE SUSTAINED AS A RESULT OF EFFORTS OF THIRD PARTIES WHO MAY COME TO MY AID. I EXPRESSLY ACKNOWLEDGE THAT SERIOUS ACCIDENTS MAY OCCUR WHILE PARTICPATING IN OR OBSERVING THE ACTIVITIES.

    I understand that my presence in, about or upon the Premises, and use of the Facilities, whether by engaging in, observing, or being present in, around or about, the Activities, exposes both myself and my property to dangerous conditions, risks and hazards, including, but not limited to: shooting myself or others, being shot by others, partial or total loss of eyesight or hearing, equipment failure or breakdown, accident or illness without access to availability of medical supplies or treatment, trauma, burns, abrasions, amputation, paralysis, brain injuries, spinal injuries, or other injuries resulting from the normal and abnormal operation of firearms, ammunition, archery, and paintball, airsoft, simunitions, and other simulated firearms equipment, inhalation or other harmful contact with lead or other contaminants containing toxic materials, which may cause or contribute to illness, disease or other short- or long-term terminal injury or ailment, being struck by flying, ricocheting or falling debris or projectiles, misfires or malfunctions of firearms, ammunition, archery, or paintball, airsoft, simunitions, and other simulated firearms equipment, and to the intentional or negligent acts or omissions of third parties present at or using the Premises or Facilities. If I am pregnant and engage in or observe the Activities, I understand all of these risks may result in harm to both myself and to my fetus. I understand that alcohol may be available at the Premises, and that consumption is strictly voluntary.

    I HEREBY EXPRESSLY ACKNOWLEDGE THE RISKS, DANGERS AND HAZARDS ASSOCIATED WITH THE ACTIVITES, MY PRESENCE IN, ABOUT OR UPON, AND USE OF THE PREMISES AND THE FACILITIES, AND OF FIREARMS, WHETHER HEREIN DESCRIBED OR NOT, AND I FREELY ACCEPT AND ASSUME ANY AND ALL SUCH RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE, AND ANY OTHER LOSS RESULTING THEREFROM.
     
  2. RELEASE AND INDEMNIFICATION. I, ON BEHALF OF MYSELF, MY NEXT OF KIN, HEIRS, GUARDIANS, REPRESENTATIVES, AGENTS, AFFILIATES, GUESTS, EMPLOYEES, EXECUTORS, ADMINISTRATORS, SUCCESSORS AND ASSIGNS (COLLECTIVELY, THE “PARTICIPANT PARTIES”), FOREVER RELEASE THE WILSHIRE PARTIES FROM ANY LIABILITY FOR DAMAGES OR INJURIES TO THE PERSON OR PROPERTY, OR BOTH, OF THE PARTICIPANT PARTIES OCCURRING IN, ON, OR ABOUT THE PREMISES AND THE FACILITIES. CUMULATIVE OF THE FOREGOING, I AGREE TO DEFEND, INDEMNIFY AND HOLD HARMLESS EACH OF THE WILSHIRE PARTIES FROM ANY AND ALL CLAIMS, SUITS, ACTIONS, CAUSES OF ACTION, DEMANDS, LIABILITIES, DAMAGES, INJURIES, LOSSES, ATTACHMENTS OF PROPERTY OR LIABILITIES OF ANY KIND WHATSOEVER, AT COMMON LAW, STATUTORY OR OTHERWISE, AND ANY AND ALL EXPENSES OR COSTS OF WHATEVER NATURE ARISING THEREFROM, INCLUDING COSTS OF LITIGATION, ATTORNEYS’ FEES, EXPERT FEES, AND ALL REASONABLE EXPENSES IN CONNECTION THEREWITH (COLLECTIVELY, THE “CLAIMS”), THAT I OR ANY OF THE PARTICIPANT PARTIES MAY HAVE FOR PROPERTY DAMAGE, PERSONAL INJURY, DEATH OR OTHERWISE ARISING OUT OF, ASSOCIATED WITH, OR RESULTING FROM MY PRESENCE IN, ABOUT OR UPON, OR THE USE OF, THE PREMISES OR THE FACILITIES, INCLUDING WITHOUT LIMITATION, MY ENGAGING IN OR OBSERVING THE ACTIVITIES, MY USE OR OBSERVANCE OF FIREARMS AND DISCHARGES THEREOF (REGARDLESS OF WHO OWNS OR CONTROLS SUCH FIREARMS), AND ANY NEGLIGENT OR OMITTED FIRST-AID OR RESCUE OPERATIONS OR PROCEDURES.

    I EXPRESSLY CONFIRM THAT IT IS MY INTENT THAT ALL INDEMNITY OBLIGATIONS AND LIABILITIES ASSUMED BY ME UNDER THE TERMS OF THIS RELEASE SHALL BE WITHOUT MONETARY LIMIT AND THAT BY EXECUTING THIS RELEASE, I EXPRESSLY AGREE TO RELEASE AND INDEMNIFY THE WILSHIRE PARTIES FROM AND AGAINST THE CONSEQUENCES OF ANY OF THE WILSHIRE PARTIES’ OWN NEGLIGENCE (WHETHER SUCH NEGLIGENCE IS ACTIVE OR PASSIVE AND WHETHER SUCH NEGLIGENCE IS THE SOLE PROXIMATE CAUSE OR A PROXIMATE CAUSE JOINTLY AND CONCURRENTLY WITH THE NEGLIGENCE OF ME OR OTHERS) RESULTING IN THE DAMAGE, INJURY OR DEATH TO THE PERSON OR PROPERTY, OR BOTH, OF MYSELF OR THE PARTICIPANT PARTIES.

    THE OBLIGATIONS TO RELEASE, DEFEND, INDEMNIFY, AND HOLD HARMLESS THE WILSHIRE PARTIES SHALL APPLY EVEN IF THE LOSSES ARE CONTRIBUTED TO OR CAUSED BY THE SOLE, JOINT, COMPARATIVE, CONTRIBUTORY, OR CONCURRENT, ACTIVE OR PASSIVE NEGLIGENCE, GROSS NEGLIGENCE, WILLFUL MISCONDUCT, FAULT OR STRICT LIABILITY OF ANY OR ALL OF THE WILSHIRE PARTIES, WHETHER OR NOT SUCH CLAIMS SHALL BE VALID OR GROUNDLESS, OR ANY BREACH OF ANY COVENANT OR AGREEMENT OF MYSELF HEREUNDER, EACH TO THE EXTENT THAT SUCH CLAIM RESULTS PARTIALLY OR WHOLLY FROM ANY ACT OR OMISSION OF ME, INCLUDING, WITHOUT LIMITATION, ANY NEGLIGENT OR GROSSLY NEGLIGENT, INTENTIONAL, RECKLESS, WANTON OR WILLFUL ACT OR OMISSION OF THE PARTICIPANT PARTIES, OR ANY ACT OR OMISSION THAT WOULD SUBJECT ME TO STRICT LIABILITY. BOTH PARTIES HERETO ACKNOWLEDGE THAT THE RELEASE AND INDEMNITY PROVISIONS CONTAINED IN THIS RELEASE ARE CONSPICUOUS AND AFFORD FAIR AND ADEQUATE NOTICE. I AGREE THAT THE RELEASE AND INDEMNIFICATION PROVISIONS OF THIS SECTION 2 ARE BINDING UPON ALL PARTICIPANT PARTIES, AND THAT THE PROVISIONS OF THIS SECTION 2 COVER ALL CLAIMS FOR WRONGFUL DEATH UNDER ANY APPLICABLE LAW.
     
  3. MEDICAL CERTIFICATION. I certify that I have no medical, physical, psychological or emotional conditions that will or could interfere with my safety and the safety of others in connection with or resulting from my presence in, about or around, engagement in, or observation of any Activities. I am of sound mind, mentally competent, and have the requisite health and fitness to be in, about or around, engagement in, or observation of any Activities. I further certify that I have adequate insurance coverage, whether through an insurance policy or self-insurance, to cover any injury or damage I cause or suffer.  In the event that I do not have such adequate insurance coverage, I agree to completely bear the cost of any such injury or damage. In the event that I (i) am pregnant or become pregnant, or (ii) develop any medical, physical, psychological or emotional conditions that might or could interfere with my safety and the safety of others, I certify that I will consult with a physician before being present in, about or around the Premises or the Facilities, or engaging in, or observing any Activities.
     
  4. SAFETY RULES AND EQUIPMENT. I agree (i) to abide by all written, video, audio, online, posted and verbally issued safety rules or instructions issued by Wilshire Gun and its instructors, range masters, safety officers, agents or employees, which safety rules and instructions may be changed from time to time; (ii) at all times, in order to safely engage in or observe the Activities, to supply my own, and use, proper safety equipment including, without limitation, appropriate eye and hearing protection and proper clothing and footwear; ; and (iii) that I will not engage in or observe any Activities whatsoever, including but not limited to handling or operating any firearm, while under the influence of, drugs (prescription or otherwise and including medical marijuana), alcohol or any controlled substance.
     
  5. ELIGIBILITY TO OWN AND USE FIREARMS. I certify that I meet the requirements of all federal, state and local laws, statutes, rules and regulations which regulate my ability to purchase, own, use or possess firearms, and that I (i) am not under indictment or information in any court for a felony, or any other crime punishable by imprisonment for a term exceeding one year; (ii) have never been convicted in any court of a felony, or any other crime punishable by imprisonment for a term exceeding one year; (iii) am not a fugitive from justice; (iv) am not an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug or any other controlled substance; (v) have never been adjudicated mentally defective or been committed to any mental institution; (vi) have not been discharged from the Armed Forces under dishonorable conditions; (vii) am not subject to a court order restraining me from owning, using or possessing a firearm; (viii) have never been convicted in any court of a misdemeanor crime of domestic violence; (ix) have never renounced my United States citizenship; (x) am not an alien who is illegally in the United States or under a nonimmigrant visa that fails to meet the qualifications for purchasing, receiving, or possessing a firearm under federal law. I further certify that if at any time in the future I become subject to any of the restrictions set forth in this Section 5, I will promptly notify Wilshire Gun.
     
  6. BACKGROUND CHECK REQUIREMENT. I understand and agree that Wilshire Gun requires each person over the age of eighteen (18) to provide a valid form of identification on each visit to the Facilities, and that I am subject to this requirement. In order to verify the requirements set forth in Section 5 above, and as consideration for my eligibility to use the Facilities and engage in or be present in, about, or around the Activities, or both, I understand and agree that Wilshire Gun reserves the right to conduct a Public Records Criminal Background Check (the “Background Check”) on each person, including myself, aged eighteen (18) and over. Any such Background Check shall be used solely for the purpose of ascertaining a person’s eligibility to own, use or possess firearms. All Background Check results will be reviewed only by the Wilshire Parties and will be kept confidential. Wilshire Gun will not maintain any records of Background Checks other than a record that a Background Check has been completed and the success or failure of same. Background Check results that reasonably indicate, in the sole discretion of Wilshire Gun, that you are not eligible to own, use or possess a firearm will result in a denial of access to the Premises, the Facilities, or both. Any person who presents a current and valid concealed handgun license or license to carry shall not be subject to Background Checks. By agreeing to this Release, I hereby authorize and consent to the performance of a Background Check regarding me by Wilshire Gun.
     
  7. CONSENT TO PAT-DOWNS. I understand and agree that all persons entering certain Facilities, including Wilshire Gun’s simulation room, are required to be searched by a physical pat-down, and that if I refuse such a pat-down, I will not be allowed to enter any such Facilities, including the simulation room. If the Wilshire Gun representative conducting the search determines the need for further examination, I will be escorted to a secondary screening area where I will be required to empty my pockets and remove any belt and/or jacket. If prohibited items are revealed during this search, I will be permitted to return to my vehicle with the items or the items will be confiscated. I agree that Wilshire Gun will not safeguard or be responsible for any personal belongings or other items.  I understand and agree that if prohibited items are revealed during the search, Wilshire Gun, it is sole discretion, may prohibit me from re-entering the Facilities or the Premises, or both.
     
  8. NO WARRANTIES. I acknowledge and agree that the Wilshire Parties make no warranty, express or implied, as to the safety, design, manufacture, maintenance, condition or fitness for any particular purpose of the Premises, the Facilities, the Activities, any equipment or any improvements, including, without limitation, firearms, ammunition, eye protection, hearing protection, first-aid supplies, target and tactical simulation systems, and HVAC and air filtration systems. I will not operate any firearms or equipment with which I am not completely familiar without first engaging the assistance or training of the appropriate Wilshire Gun personnel.
     
  9. SEVERABILITY. I acknowledge that this Release is intended to be broad and inclusive.  If any term, provision, or Section of this Release is determined by an arbitrator or court of competent jurisdiction to be invalid, illegal or incapable of being enforced for any reason, all other terms, provisions and Sections of this Release shall remain valid and continue in full force and effect, and such term, provision or Section shall be deemed modified to the minimum extent necessary to make it consistent with applicable law and, in its modified form, such  term, provision or Section shall then be enforceable and enforced.
     
  10. DISPUTE RESOLUTION; AGREEMENT TO ARBITRATE. In the case of any dispute, claim or controversy arising out of or relating to this Release or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this agreement to arbitrate (each, a “Dispute”), the parties shall first make an earnest effort to settle such Dispute to their mutual satisfaction. If such Dispute cannot be reconciled by the parties within fifteen (15) days of the initial notice of the Dispute, then the Dispute shall be submitted for binding arbitration pursuant to terms of the Federal Arbitration Act.  The dispute or controversy shall be submitted for resolution to a board of arbitration in Oklahoma City, Oklahoma, composed of one member. Such arbitration shall be conducted pursuant to the rules of the American Arbitration Association (the "AAA"), Commercial Rules (expedited version) and a decision of the board of arbitration (including an award of costs) shall be final and binding upon the parties.
     
  11. GOVERNING LAW AND VENUE. I agree that this Release shall be governed by, construed and enforced in accordance with the laws of the State of Oklahoma, without regard to conflicts of laws principles. In the event that arbitration is disallowed for any reason, I hereby irrevocably submit to the sole and exclusive jurisdiction of any federal or state court located or sitting within Oklahoma County, Oklahoma over any Dispute and irrevocably agree that all claims in respect of such Dispute shall be heard and determined exclusively in such courts. I further submit to the personal jurisdiction of such courts, and hereby irrevocably waive, to the fullest extent permitted by applicable law, any objection which I may now or hereafter have to the agreed venue of such Dispute brought in such court or any defense of inconvenient forum for the maintenance of such Dispute. I agree that a judgment in any such Dispute may be enforced in other jurisdictions by suit on the judgment or in any other manner provided by law. In the event that a Dispute is resolved in federal or state court as described in this Section 11, each party shall bear its own costs of litigation, including all attorneys’ fees, costs and expenses resulting therefrom.  I HEREBY IRREVOCABLY AND UNCONDITIONALLY WAIVE TRIAL BY JURY IN ANY LEGAL ACTION OR PROCEEDING ARISING OUT OF OR RELATING TO THIS RELEASE OR ANY DISPUTE.
     
  12. BINDING FUTURE EFFECT; TERMINATION; ELECTRONIC COPIES. I agree that, for my own convenience, this Release shall be effective and apply to all of my present and future (i) use of the Premises or the Facilities; (ii) presence in, on, or about the Premises or the Facilities, and (iii) engagement in or observation of any Activities at the Premises or the Facilities. I understand and agree that: (w) this Release shall remain effective until either party revokes this Release in writing; (x) upon acceptance by me, this Release supersedes any and all prior releases; (y) this Release may be amended or revised from time to time and if I fail or refuse to accept such revised or amended Release, Wilshire Gun may prohibit me from entering, accessing or using the Premises or the Facilities or engaging in or observing Activities; and (z) nothing in this Release shall be construed as a continuing license for me to access or use the Premises, or the Facilities, or engage in or observe Activities. This Release may be accepted by handwritten or electronic signature, by electronic means on the internet site of Wilshire Gun, and by facsimile or email (including in pdf format), each of which shall be a binding and enforceable original of this Release.
     
  13. PHOTOGRAPHIC AND FILM RELEASE AND EMAIL MARKETING. I understand and agree that Wilshire Gun and the Wilshire Parties reserve the right to take photographic or film records of me during my presence in, on, or about the Premises or the Facilities, and I hereby agree that Wilshire Gun and the Wilshire Parties may use any such photographic or film records for promotional and/or commercial purposes as well as approve such use by third parties with whom Wilshire Gun or the Wilshire Parties may partner for a joint marketing effort, and that Wilshire Gun and the Wilshire Parties shall not owe me or any of the Participant Parties any compensation for such use. Further, I understand and agree that Wilshire Gun and the Wilshire Parties reserve the right to maintain email addresses, phone numbers and utilize them for email marketing and telephonic or text marketing campaigns for Wilshire Gun.
     
  14. KNOWING AND VOLUNTARY EXECUTION. BY EXECUTING THIS RELEASE, I REPRESENT AND WARRANT THAT (A) I HAVE HAD THE OPPORUTNITY TO READ AND UNDERSTAND THIS RELEASE, AND I HAVE DONE SO; (B) I UNDERSTAND AND VOLUNTARILY AGREE TO EACH TERM OF THIS RELEASE, AND I UNDERSTAND THAT THIS IS A FULL RELEASE OF ANY AND ALL OF THE WILSHIRE PARTIES; (C) I AM UNDER NO DURESS OR REQUIREMENT TO AGREE TO THIS RELEASE, NOR AM I REQUIRED TO ACCESS OR USE THE PREMISES, OR THE FACILITIES, OR ENGAGE IN OR OBSERVE ANY ACTIVITIES; (D) NO REPRESENTATIONS OR STATEMENTS HAVE BEEN MADE TO ME ABOUT THE SAFETY OF THE PREMISES, THE FACILITIES OR ACTIVITIES, INCLUDING BUT NOT LIMITED TO THE QUALITY OR SUITABILITY OF THE PREMISES, THE FACILITIES OR THE IMPROVEMENTS LOCATED THEREON; (E) I HAVE NOT BEEN INDUCED TO AGREE TO THIS RELEASE BY THE STATEMENT OR CONDUCT OF ANY PERSON; (F) I AGREE THAT EACH TERM OF THIS RELEASE IS THE PRODUCT OF AN ARMS’ LENGTH TRANSACTION AND THAT EACH PROVISION SHALL STAND ALONE IF ANY PROVISION IS DEEMED INVALID OR UNENFORCEABLE; (G) I HAVE HAD AN OPPORTUNITY TO SEEK INDEPENDENT LEGAL REVIEW OF THIS RELEASE; (H) I HAVE THE MENTAL COMPETENCY TO UNDERSTAND AND AGREE TO THIS RELEASE; AND (I) I AGREE TO THIS RELEASE OF MY OWN FREE WILL.  I FURTHER UNDERSTAND THAT BY AGREEING TO THIS RELEASE, I VOLUNTARILY SURRENDER SPECIFIC LEGAL RIGHTS AND REMEDIES.
First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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*
Understanding and Agreement

I HAVE READ, UNDERSTAND AND VOLUNTARILY AGREE TO THIS RELEASE, WAIVER OF LIABILITY, INDEMNIFICATION, AND ARBITRATION AGREEMENT, including the agreement to arbitrate and assumption of risk, on behalf of myself and anyone that may claim through me, or on my behalf, and further agree that no oral representations, statements or inducement that are not reflected herein have been made to me by any of the Wilshire Parties or any person. I understand and agree that this is an UNCONDITIONAL RELEASE and a binding legal document. If I am unsure about any provisions in this Release, I WILL NOT agree to it, and will seek the advice of legal counsel before agreeing to this Release.

By clicking this box, I certify that the above is true: *
Yes
Parent/Guardian Permission - Release, Waiver, of Liability, Indemnification, and Arbitration Agreement, and Assumption of Risk I certify that I am the below child’s parent or legal guardian. As such, and individually, I have carefully read this Release in its entirety, fully understand its contents, and hereby agree to its terms. I give the child permission to be present in, on, or about the Premises and the Facilities, or participate in or observe the Activities, or both. I further certify that the child is in good physical and mental health and in proper physical condition for participation in or observance of the Activities.


By signing below the parent or court-appointed legal guardian agrees that they are also 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 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 - TRY IT FREE!