KSC Youth & Non-member Guest Acknowledgement of Risk

KUNEYTOWN SPORTSMEN'S CLUB ACKNOWLEDGEMENT OF RISK 

This form must be completed for non-members and youth to participate in KUNEYTOWN SPORTSMEN'S CLUB RANGE and related activities.

I hereby acknowledge the risks for my child to participate in the activity indicated below to be conducted by the designated  Kuneytown Official and acknowledge as follows: 

I fully understand and acknowledge that there are inherent risks and dangers in my child's participation in the Kuneytown Range activities and my child's participation in Kuneytown Sportsmen's Club and all its activities and use of any equipment related to such activities may result in injury, illness or death and damage to personal property. 

I understand other participants, accidents, forces of nature or other causes may cause these risks and dangers and I hereby accept these risks and dangers. 

My child is in good health and is at or above the minimum age of required to participate in this activity and is able to participate in any strenuous physical activity associated therewith. 

I have read the  above and by signing it I agree it is my intention to have my child participate in the indicated activity and I understand and accept the risks involved. This shall be binding on my heirs, successors, assigns, administrators and executors. Any claims or disputes arising out of my child's participation in the activity shall be venued in the Supreme Court of the State of New York of Seneca County where Kuneytown Sportsmen's Club is located. 

I am at least twenty-one (21) years of age and I am the legal parent/guardian authorized to sign this document on behalf of the child named herein.

Youth Signature:  ___________________________________________________ Date   /   /     

Parent or Guardian Name (please print) _________________________________

Parent or Guardian Signature __________________________________________   Date   /   /