New Shooters Application and Liability Release Please Complete with All Information

Cowboy Action Shooting Club

New Shooters Application and Liability Release – Please Complete with All Information

Print/Complete & Deliver or Mail To: New Shooter, Tejas Caballeros, 8545 Ranch Road 1623, Blanco, TX 78606-5170

Questions ~ Call: 512-964-9955 or e-mail: Thomas Pollock (aka: Judge Menday Coming)

Please Type or Print Legibly

Applicant Information

Date: ______New Shooters Application _____

Name: ______Alias: ______

Address: ______City: ______State: ___ Zip: _____ Home Phone: ______Cell Phone: ______Email: ______

Date of Birth: ______(Applicants must be at least 21 years of age or sponsored by parent or guardian)

Medical Emergency and Contact Information

Allergies or Conditions: ______

Emergency Contact: ______Phone Number: ______

More Information:

SASS Member: _____ Yes/No _____ Number: ______NRA Member: _____ Yes/No _____Number: ______

NRA Member: _____ Yes/No _____Number: ______

Release of Liability Affidavit

By signing below, I CERTIFY that I am not precluded from possessing a firearm by law, that I know how to safely handle the firearms I use, know the safety rules that pertain to firearms and their use, and I will always follow such rules while at any Tejas Caballeros function. I accept and assume the risks associated with firearms use by me and others. I do hereby release and discharge the Tejas Caballeros and their officers, representatives, agents, servants, directors, employees, and/or any land owner or operating facility associated with the Tejas Caballeros, from any and all liability, of every kind and character, howsoever arising, including bodily injuries and loss or damage of property, sustained by me, my guest, and any other person or entity, having or asserting claims or rights, by, through, or under meEven though caused in whole or in part by the negligence (whether sole, joint or concurrent), gross negligence, strict liability or other legal fault of the Tejas Caballeros and their officers, representatives, agents, servants, directors, employees, and/or any land owner or operating facility associated with the Tejas Caballeros (or any such indemnities).I covenant and agree to hold harmless and indemnify the said entities and persons from any claims of the nature released or discharged, arising by, through, or under me. I grant Tejas Caballeros the right to use photographs and video recordings of me participating in Tejas Caballeros events or at the Texas Republic Ranch for any lawful purpose, including without limitation, printed, electronic, and video content. This affidavit is binding until January 31, 20____ at any and all gatherings of the Tejas Caballeros.

______

Legal SignatureDatePrinted Name

Minor Release of Liability

I, the undersigned below, do certify as parent, guardian, or custodial parent, on behalf of my minor child or ward, the above referenced release of liability, and grant expressed permission for my minor child or ward to participate in club activities.

______

Parent or Guardian Legal SignatureDatePrinted Name

For Office Use only

Date Paid: ______Amount Paid: ($25/person)______Received by: ______Cash: __ or Check #:______Revised 01/13/2017