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Winchester Canyon Gun Club

Eyewitness Incident/Accident Form

To ensure the safety of all members, guests, and employees, WCGC has a comprehensive safety plan in place. One part of this plan is personal accounts of any incidents and/or accidents. 

The person involved and/or witness to any incident/accident on the WCGC property resulting in injury to or death of any persons, damage to any range or personal property or violation of any WCGC Range Safety Rules shall, as soon as practical, give notice of the incident/accident to WCGC Range Personnel both verbally and in writing. 

My signature below certifies that the information I have provided is true and accurate.

I Agree

Witness Signature:

Signature of Parent / Legal Guardian required if participant is under age of majority.

Date: May 31, 2025




First Witness Name
First Name*
Last Name*
Phone*
First Witness Age Acknowledgment*
First Witness Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
First Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
First Witness Signature*
Second Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Second Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Third Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Third Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Fourth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Fourth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Fifth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Fifth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Sixth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Sixth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Seventh Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Seventh Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Eighth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Eighth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Ninth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Ninth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
Tenth Witness Name
First Name*
Last Name*
Witness Date of Birth*
Date of Birth
Tenth Witness
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
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.
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*
Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 18 years of age or older
Parent or Guardian's
Are you a current member of WCGC?*
No
Yes

What did you see?

What did you hear?

What did you do?
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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