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Insurance Wavier Form (required for all new members and guests)
April 3, 2016
1:10 pm
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Amark
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Forum Posts: 176
Member Since:
August 21, 2012
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                                              RELEASE, INDEMNIFICATION, and HOLD HARMLESS AGREEMENT
In consideration of participating in gun club activities including hunting, range, and fishing activities, and for other good and valuable  consideration, I hereby Agree to release end discharge from liability arising from negligence The Lagrange Hunting and Fishing Club, lnc. and its owners, directors, officers, employees, agents, volunteers, participants, and all other persons or entities acting for them (hereafter collectively referred to as "Releases") on behalf of myself and my children, parents, heirs, assigns, personal representative and estate, and also agree as follows;

1. I acknowledge that gun club or hunting activities involve known and unanticipated risks which could result in physical or emotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, death or serious injury as a result of being shot or as a result or as a remit of equipment malfunction, hearing loss, loss of vision, broken bones, bruises and other bodily injuries caused by fails, medical conditions resulting from physical activity, and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without Jeopardizing the essential qualities of the activity.

2. I expressly accept and assume all of the risks inherent in the activity or that might have been caused by the negligence of the Releases. My participation in this activity is purely voluntary and I elect to participate despite the risks. In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releases from any and all claims, demands, or cases of action which are in any way connected with my participation in this activity, or may lie of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct Should Releases or anyone acting on their behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnity and hold them harmless for all such fees and costs.

4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition which could interfere with my safety in this activity, or else I am willing to assume and bear the costs of, all risks that may be created, directly or indirectly, by any such condition.

5. In the event that I file a lawsuit, I agree to do so solely in the state where Releases facility is located, and I further agree that the substantive law of the state shall apply.

6. I agree that if any portion of the agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I agree that if I am hurt or my property is damaged during my participation in this activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released on the basis of any claim for negligence.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior to signing, Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release, and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understand this document and I agree to be bound by its terms.

Signature______________________________________ Print Name ____________________________________

Address  _______________________________ City ___________________ State _____ Zip____

Telephone (___ ) ______    _________ Date ___ / _____/ __________

PARENT OR GUARDIAN ADDITIONAL AGREEMENT (Must be completed for participants under the age of 18 )
In consideration of__________________________________________ (PRINT minors name) being permitted to participate in this activity, I further agree to Indemnify and hold harmless Releases from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor.

Parent or Guardian_________________________ Print Name ______________________Date____ / ______/ _____

(If notarization is necessary, please sign & stamp this side of form)

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