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Participants must complete our liability waiver.  Please note that answering yes to any sensitive question will deny you service.  You can not participate if a convicted felon.  

I Agree
  In accordance with FSS 790.23 it is unlawful for any person to own or have in his or her care, custody, possession, or control any firearm, ammunition, or electronic weapon or device, or to carry concealed weapon, including a tear gas gun or chemical weapon or device, if that person has been convicted of a felony in the courts of this state.  If convicted of Actual Possession of a Firearm by a Convicted Felon, a judge is required to impose a minimum-mandatory sentence of three-years in prison and can also impose any combination of the following penalties: Up tp fifteen years in prison, up to fifteen years probation, and up to $10,000.00 in fines.

YOU MUST BE AT LEAST 21 YEARS OLD TO RENT ANY FIREARM OR CLASS 3 WEAPON AND SHOW A VALID DRIVERS LICENSE OR STATE-ISSUED ID CARD.  ANYONE SUSPECTED OF BEING UNDER THE INFLUENCE OF A DRUG OR ALCOHOL, OR IMMENATING THE ODOR OF USAGE, WILL NOT BE ALLOWED IN THE RANGE.  THE SHOOTING GALLERY RANGE, INC RESERVES THE EXCLUSIVE RIGHT TO REFUSE SERVICE TO ANYONE FOR ANY REASON.

I Agree
I have been shown, or have displayed, proper and safe operation of the firearm I will be using.  I hereby release THE SHOOTING GALLERY RANGE, INC, IT'S OWNERSHIP, OFFICERS & MEMBERS,  MANAGEMENT, AND EMPLOYEES, AS WELL AS THE LANDLORD, COX PLAZA, INC, (COLLECTIVELY THE SHOOTING GALLERY RANGE, INC) from any and all liability for any personal injury or property damage arising out of the use (by me or any third party), in any way, of the facility, its equipment or firearms, or my firearm.  I agree to hold THE SHOOTING GALLERY RANGE, INC, hamless and idemnify, THE SHOOTING GALLERY RANGE, INC, from responsibility for any claims or demands arising out of such use (by me or any third party).  I agree to be held financially responsible for any damage or destruction caused by me to the range, range equipment, or any property owned by a third party.  I agree to be held financially responsible for all claims or demands by any third party who is harmed by my actions while I am present at the Shooting Gallery Range, Inc.  I have read, understand, and agree to abide by all Range Rules (see additional rules section).  If any information changes I agree to notify THE SHOOTING GALLERY RANGE, INC. as quickly as possible and before additional usage of the facility.

RELEASE OF MINOR'S RIGHTS

READ THIS WAIVER COMPLETELY AND CAREFULLY.  YOU ARE AGREEING TO ALLOW YOUR MINOR CHILD TO ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY.  YOU ARE AGREEING THAT, EVEN IF THE SHOOTING GALLERY RANGE, INC USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE THAT YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CAN NOT BE AVOIDED OR ELIMINATED.  BY ELECTRONICALLY SIGNING THIS FORM OR ON PAPER COPY, YOU ARE GIVING UP BOTH YOUR CHILD'S RIGHT AND YOUR RIGHT TO RECOVER FROM THE SHOOTING GALLERY RANGE, INC IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE SHOOTING RANGE ACTIVITY.  YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND THE SHOOTING GALLERY RANGE, INC HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.  AS THE PARENT OR GUARDIAN, YOU AGREE TO BE HELD LIABLE FOR ANYTHING THAT RESULTS FROM THE MINOR'S ACTIONS INCLUDING, BUT NOT LIMITED TO, FINANCIAL IMPLICATIONS, PHYSICAL DAMAGE, AND/OR DEATH.

I Agree

 

First Participant Name

First Name*

Middle Name

Last Name*

Phone*
First Participant Date of Birth*
First Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
First Participant Signature*
Second Participant Name

First Name*

Middle Name

Last Name*
Second Participant Date of Birth*
Second Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Third Participant Name

First Name*

Middle Name

Last Name*
Third Participant Date of Birth*
Third Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Fourth Participant Name

First Name*

Middle Name

Last Name*
Fourth Participant Date of Birth*
Fourth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Fifth Participant Name

First Name*

Middle Name

Last Name*
Fifth Participant Date of Birth*
Fifth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Sixth Participant Name

First Name*

Middle Name

Last Name*
Sixth Participant Date of Birth*
Sixth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Seventh Participant Name

First Name*

Middle Name

Last Name*
Seventh Participant Date of Birth*
Seventh Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Eighth Participant Name

First Name*

Middle Name

Last Name*
Eighth Participant Date of Birth*
Eighth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Ninth Participant Name

First Name*

Middle Name

Last Name*
Ninth Participant Date of Birth*
Ninth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
Tenth Participant Name

First Name*

Middle Name

Last Name*
Tenth Participant Date of Birth*
Tenth Participant Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
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*
Check to receive information, news, and discounts by e-mail.
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.


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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Have you ever been adjudicated mentally defective, been committed to a mental institution, or have a history of mental illness or severe depression?*
Are you a US Citizen or permanent resident alien?*
Have you ever been convicted of a felony, act of domestic violence, or restricted by law from using a firearm?*
Are you an unlawful user of, have a medical card for, or addicted to marijuana, depressant, stimulant, narcotic, or any other controlled substance?*
Female shooters - Are you or is there a chance you are pregnant?*
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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