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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: October 22, 2024




First Witness Name

First Name*

Last Name*

Phone*
First Witness Age Acknowledgment*
First Witness 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*
Second Witness 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*
Third Witness 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*
Fourth Witness 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*
Fifth Witness 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*
Sixth Witness 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*
Seventh Witness 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*
Eighth Witness 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*
Ninth Witness 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*
Tenth Witness 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*
A signed copy of this waiver will be sent to the email address you provide.
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*
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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