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The individual named below (referred to as “I” or “me”) desires to attend or participate in MEMBERSHIP(“Activity”) at Impact Shooting Center, LLC (“Company”). As lawful consideration for being permitted by the Company to participate in the Activity, I agree to all the terms and conditions in this WAIVER, RELEASE OF LIABILTY, AND ASSUMPTION OF RISK (“Agreement”).


I AM AWARE AND UNDERSTAND THAT THE ACTIVITY IS DANGEROUS AND INVOLVE THE RISK OF SERIOUS INJURY AND/OR DEATH AND PROPERTY DAMAGE. I ACKNOWLEDGE THAT THE HANDLING AND USE OF FIREARMS IS DANGEROUS. I ACKNOWLEDGE THAT ANY INJURIES THAT I SUSTAIN MAY BE COMPOUNDED BY NEGLIGENT EMERGENCY RESPONSE OR RESCUE OPERATIONS OF THE COMPANY. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITY WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DEATH OR PROPERTY DAMAGE, WHETHER CAUSED BY THE NEGLIGENCE OF THE COMPANY OR OTHERWISE.  I UNDERSTAND THAT I AM UNDER NO DUTY OR OBLIGATION TO PARTICIPATE IN THIS ACTIVITY AND I MAY CEASE ACTIVITY AT ANY TIME.  


I expressly waive and release all claims against the Company, and its officers, directors, instructors, employees, agents, affiliates, members, successors and assigns (collectively, “Releasees”), arising out of or attributable to my participation in the Activity, whether arising out of the negligence of the Company or any Releasees. I agree not to make or bring any claim against the Company or any other Releasee, and forever release and discharge the Company and all other Releasees from liability under such claims.   


  

I shall defend, indemnify and hold harmless the Company and all other Releasees against any and all losses, damages, liabilities, deficiencies, claims, actions, judgments, settlements, interest, awards, penalties, fines, costs, or expenses of whatever kind, including reasonable attorney fees, fees and the costs of enforcing any right to indemnification under this Agreement and the cost of pursuing any insurance providers, arising out or resulting from any claim of a third party related to the Activity. 


I acknowledge that this Activity may involve a test of a person’s physical and mental limits and may carry with it the potential for serious injury and/or death, and property loss. The risks may include, but are not limited to, those caused by the handling, operation, and firing of firearms, terrain, facilities, temperature, weather, condition of participants, equipment, actions of other people including, but not limited to, participants, volunteers, and/or instructors.  


  


I certify that I am physically fit and have not been advised to not participate by a qualified medical professional. I certify that there are no health-related reasons or problems which preclude my participation in this Activity.  


   


I consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness, including transportation for medical treatment, during this Activity. I understand that I, not the Company, shall be responsible for all charges for such health care services and transportation regardless of whether my medical insurance would cover such charges. 


This Agreement constitutes the sole and entire agreement of the Company and me and supersedes all prior understandings, agreements, representations and warranties, both written and oral. If any term or provision of this Agreement is unenforceable it shall not affect any other term or provision of this Agreement. This Agreement is binding on and shall inure to the benefit of the Company and me and their respective successors and assigns. All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of Ohio without giving effect to any conflict of laws provisions. Any claim or cause of action arising under this Agreement may be brought only in the federal and state courts located in Cincinnati, Ohio and I hereby consent to the exclusive jurisdiction of such courts.  


   



First Member Name
First Name*
Last Name*
Phone*
Select Gender
First Member Date of Birth*
Date of Birth
First Member Signature*
Second Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Third Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Fourth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Fifth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Sixth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Seventh Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Eighth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Ninth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Tenth Member Name
First Name*
Last Name*
Phone*
Select Gender
Member Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
Photo ID

If you are LE, first responder or active/former military, upload your credentials (i.e. military ID, DD214, badge, etc).

If you have a concealed carry permit, upload a picture of your concealed carry license. 

If you do not have any of the above, please upload a picture of your driver's license/state ID. 

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Valid file types: JPG, GIF, PNG, and PDF
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*
Last Name*
Relationship*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
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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