March 31st, 7:00 PM

Smithtown American Legion Post 833
51 Juniper Avenue, Smithtown

Shooting Range Session

To use the range, please have release form signed (on back)

LIABILITY WAIVER AND RELEASE

In consideration of the Troop 272, Suffolk County Council, BSA., presenting the opportunity to engage in the shooting sports

I, _______________________________________, hereby agree as follows: (Print Name)

1) I UNDERSTAND that while firearms are regularly handled and fired safely by those following proper safety procedures, the handling of firearms and participating in firearms training and the shooting sports can be dangerous activities. I understand that I am responsible for complying with all of the firearm safety rules, directions, and instructions given by instructors and range officers, as well as with all posted range rules and signs. I understand and voluntarily agree to personally assume any and all of the liability and risks associated with shooting and / or handling firearms.

2) I WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the Suffolk County Council, BSA., Troop 272, St. Joseph R.C. Church, and American Legion Post 833, including its officers, directors, agents, and members, as well as any participating training counselors, instructors or range officers (hereinafter “The Releasees”).

3) I RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense to person or property that I or my next of kin may suffer due to any cause whatsoever including NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE ON THE PART OF THE RELEASEES.

4) I HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to property of, or personal injury to, any third party resulting from my participation in the “Shooting Sports Program”.

5) THIS AGREEMENT shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives in the event of my death or incapacity.

6) IF ANY PART of this agreement is found to be invalid, The remaining parts of this agreement shall remain in force.

In entering into this Agreement, I am not relying upon any oral or written representations or statements made by The Releasees other than what is set forth in this Agreement.

I HAVE READ AND I UNDERSTAND THIS AGREEMENT. I AM AWARE THAT BY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES.

SIGNED THIS , day of , 20 __

__________________________________ _________________________________

(signature of participant) signature of parent/legalguardian if minor