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Updated 3rd Annual COASTAL CLAYS

PARTICIPANT & VOLUNTEER & TRAPPER

RELEASE FORM 2020

 

Release of Liability

RELEASE FROM RESPONSIBILITY, WAIVER OF LIABILITY AND ASSUMPTION OF RISK FOR PARTICIPATION IN A DANGEROUS ACTIVITY.

FOR AND IN CONSIDERATION of permitting THE UNDERSIGNED to participate in shooting activities on Mullek Farms, Joe & Betty Mullek premises, and the Coastal Clay Sporting event for the purposes of firearms use, shooting firearms, observing the shooting of firearms, or any and all other purposes, THE UNDERSIGNED, for herself, himself, her/his heirs, executors, administrators and assigns:

Hereby voluntarily releases discharges, waives and relinquishes any and all actions for the personal injury, property damage or wrongful death occurring to the UNDERSIGNED arising as a result of engaging in or being present at the activities at the COASTAL CLAYS of Alabama, INC., Mullek Farms, Joe & Betty Mullek premises.

Acknowledges that the UNDERSIGNED has been fully and completely advised of the potential for serious accident incidental to engaging in firearm activities, and expressly agrees to assume all risks of loss, injury and property damage, and expressly agrees to assume all risks of loss, damage or injury that may be sustained by the UNDERSIGNED.

I, the undersigned do hereby release and discharge (1) Mullek Farms, Joe & Betty Mullek, Tim & Roberta Mullek “Coastal Clays of Alabama, INC.”, their officers, directors, employees, agents and appointees including associates, agents, invitees, employees and subcontractors, ("Indemnitees") and (2) companies subsidiary to, parent to, or affiliated with Indemnitees: (3) the executive personnel of all companies included in the foregoing (4) and insurers of any of them (hereinafter the group) against any and all claims that I may have as a result of my participation in the Coastal Clays on August 8th & 15th, 2020. Furthermore, I hereby state that I am aware of the risks, hazards, and dangers associated with the Coastal Clays sponsored by the group. I understand that my participation in the Coastal Clays on August 8th & 15th, 2020 is conditioned upon my signing this Release.

I do hereby irrevocably authorize the Group, its successors and assigns and those acting under its permission authority to copyright, use and publish, for any art, advertising, trade or any other lawful purpose whatsover video reproductions or still photography reproductions of me in which I may appear in whole or in part in conjunction with my participation of the Coastal Clays on August 8th & 15th, 2020. I do hereby waive any right that I may have to inspect or approve the finished product for the advertising that may be used in conjunction therewith or the use to which it may be applied. I hereby release and discharge the Group, its successors and assigns and all persons acting under its permissions and authority for any liability by virtue of the use of the video or still reproductions and waive any claim to payment or any other remuneration from any publication, sell or use thereof.

THE UNDERSIGNED HAS READ THE FOREGOING PARAGRAPHS AND VOLUNTARILY SIGNS THIS AGREEMENT BEING FULLY AWARE OF THE LEGAL CONSEQUENCES OF THE SIGNED INSTRUMENT WITHIN

I Agree

Coastal Clays PARENTAL/GUARDIAN COVID-19 CONSENT FORM AND LIABILITY WAIVER

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and as a result, social distancing is recommended. Coastal Clays will follow state and local standards of conduct and has put in place reasonable preventative measures to reduce the spread of COVID-19 at its 2020 Clay Shoot activities (including but not limited to the clay shoot and trapper training). However, even though such standards will be followed and reasonable measures put into place, Coastal Clays cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending the Coastal Clay activities could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and that my child(ren) and I may be exposed to or infected by COVID-19 by participating in the Coastal Clay activities and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at Coastal Clay activities may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Coastal Clay volunteers, and program participants and their families. Considering the foregoing, however, I, grant permission for my child, to participate in the Coastal Clay activities at the clay shoot site, notwithstanding the risks associated with the COVID-19 virus and group activities. I further agree on behalf of myself, my child named herein, and my spouse, our heirs, successors, and assigns, to release, indemnify, and hold harmless Coastal Clays, their members, directors, officers, agents and representatives (“Indemnitees”) associated with the event arising from or in connection with the negligent acts or omissions of the Indemnitees ONLY in regard to prevention of the spread of the COVID-19 virus. I SPECIFICALLY ACKNOWLEDGE AND AGREE TO THE FOREGOING. 

Today's Date: March 28, 2024

First Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's & Volunteers & Trappers Date of Birth*
First Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
First Participant's & Volunteers & Trappers Signature*
Second Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Second Participant's & Volunteers & Trappers Date of Birth*
Second Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Third Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Third Participant's & Volunteers & Trappers Date of Birth*
Third Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Fourth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Fourth Participant's & Volunteers & Trappers Date of Birth*
Fourth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Fifth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Fifth Participant's & Volunteers & Trappers Date of Birth*
Fifth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Sixth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Sixth Participant's & Volunteers & Trappers Date of Birth*
Sixth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Seventh Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Seventh Participant's & Volunteers & Trappers Date of Birth*
Seventh Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Eighth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Eighth Participant's & Volunteers & Trappers Date of Birth*
Eighth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Ninth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Ninth Participant's & Volunteers & Trappers Date of Birth*
Ninth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Tenth Participant's & Volunteers & Trappers Name

First Name*

Middle Name

Last Name*
Tenth Participant's & Volunteers & Trappers Date of Birth*
Tenth Participant's & Volunteers & Trappers Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information about next years 4th Annual Coastal Clays Event in 2021.
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.


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 Information
Check either Participant/shooter or Volunteer or Trapper *
Participant/Shooter
Volunteer
Trapper

If you are a Participant/Shooter Type name of your team or sponsor
Check your T-shirt size (pick One)
Medium
Large
X-Large
2x Large
3x Large
Check whose Team you will be shootng for: *
Team Premier Medical
Team Budweiser
Team Alabama Ag Credit
Team Fibertech Industries
Team Bertolla Farm Supply
Team Agromax
Team Phytogen Cottenseed
Team Esfeller Construction
Team Layco Marine 1
Team Layco Marine 2
Team Flowerwood (Loxley Logistics)
Team Sunsouth
Team SSIU
Team Baldwin EMC
Team Campbell Hardware
Team Helena
Team Charles Bradford
Team Oneil/White
Team Ladd Supply
Team Mark Delaney
Team Wholesale Solutions
Team Klumb Forest Products
Team Tri-State Maritime Services
I do not know??
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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