Membership Application

Transcription

1 Centralia Rifle Club & Junior Division A Washington not-for-profit corporation 908 Johnson Road, P.O Box 465, Centralia, WA (360) Membership Application Amount: $ Dues are $140 per calendar year. For new members without a Concealed Weapons Permit there is an additional non-refundable $25 fee. Member Name: (Last, First, Middle) Date: Date of Birth: Sex: Male Female Last 4 of SSN: Address: City: Zip: Phone: #: Home: Work: Cellular: E-M AIL Address (es): Do you have a Concealed Weapons Permit? Yes No (please attach copy of concealed weapons card to application) Are you an NRA Member? Yes (Please attach copy of NRA card to application) No (All Members of the Centralia Rifle Club must be members of the NRA) List previous marksmanship training and experience: Please check all of the following you might be interested in: Pistol League Firearms Safety Class Publicity & Advertising Newsletter/Website Rifle League Home Defense Class Club Maintenance Working w/youth Bowling Pin League Become an NRA Instructor Administration Silhouette Shoots Fund-raising Activities Become an NRA Coach Other Event The following information is requested in order to comply with requirements of the U.S. Department of Civilian Marksmanship. Applicants are not required to answer. Have you ever been arrested, other than for a minor traffic violation? Yes No If Yes, State, date, county, charge and outcome: Please list the names of other immediate family who reside in your household that will use the club: NAME: Date of Birth: Sex: M F Concealed Weapons License # How did you hear about CRCJD? Website Internet Search Referral Facebook Newspaper

2 To The Officers and Members of the Centralia Rifle Club, I understand and agree to the following: 1. I, and the individuals that I bring with me as guests, will shoot only the calibers and cartridges listed on Attachment A to this letter in the Centralia Rifle Club Range. If I have a caliber or pistol cartridge which isn t on the list, I have to seek to have it added before I can use it. 2. I won t hang targets on the vertical posts on the Range, or to the horizontal plank in front of the sand bunker. If I inadvertently shoot into the vertical or horizontal wooden surfaces, I ll report it the same day by phone to one of the club officers. 3. I won t shoot at steel, movable, breakable or other action targets except under the direct supervision of a Range Safety Officer. 4. I won t shoot from any place other than the 50 ft. firing line. If I want the targets closer, I ll use the portable target stands, which may be at any distance from the firing line. I will not use the air rifle backstops. 5. I will make certain that these rules are followed, by any guests that I bring to the range and by member or their guests who are using the range at the same time I AM. 6. If I am found by door log evidence or any other means to have violated any of these rules and not immediately reported the violation to a club officer, I understand the following will happen. A. Following a hearing, my membership will be suspended and terminated. B. I will be held responsible for the cost of repairing the damage caused by my activities, which may include being sued in the Lewis County District Court. C. If the violation is a serious one, criminal charges of malicious mischief may be sought against me. 7. I agree to these because I want our club to remain a safe place for individuals to shoot without supervision. Date

3 SAFETY'RULES' ' Treat all firearms as if they are loaded at all times. Always keep the muzzle of your weapon pointed in a safe direction. Within the Centralia Rifle Range, this is downrange. Keep your finger off the trigger until you are ready to fire. Always keep your weapon unloaded until you are told to load by the Range Safety Officer, or until you are on the firing line and ready to fire. Eye and ear protection must be worn by all persons on the range, including spectators and visitors. Follow the orders of the Range Officer. If no range officer is present, informal groups of shooters should select a person to control their shooting activities. No intoxicating substances, nor persons under the influence of an intoxicating substance, illegal drug or prescription drugs, which would affect your ability to safely use firearms, are allowed on the range. All firing must be done from the 50 foot firing line. If you wish to have targets closer than 50 ft., mount paper targets on the movable target frames. To use movable target frames at less than 50 ft., lower the 50 ft. steel target holder (to it s lower position), to avoid accidentally hitting it. Horseplay. Running and unnecessary conversations during firing periods are prohibited. Violations of these safety rules, or the instructions of a Range Safety Officer may lead to discipline, including but not limited to: o Ejection from the range. o Suspension of membership o Termination of membership I have received, read, and understand these safety, range, and administrative rules and agree to follow them. I understand that this form must be signed and turned in with my membership application. Member Signature Date Revised 04/16/15

4 RANGE&RULES& & Shooters under age 18 years of age may not shoot on the range, unless accompanied by and under the constant supervision of an adult member. No junior shooter under the age of 10 may fire a rifle on the range unless they have completed an NRA basic rifle course or have obtained a written waiver from the Board of Directors. No junior shooter under the age of 12 may fire a pistol on the range unless they have completed an NRA basic pistol course or obtained a written waiver from the Board of Directors. Only.22 caliber rimfire rifles are allowed on firing points on the north side. No.17 or.22 magnum ammunition is allowed on points firing points NO EXCEPTIONS! Any standard pistol caliber.45 or under, including.17 rimfire, &.22 magnum may be used on firing points 1-12 on the south side. Any.17 Rimfire,.22 magnum, or.22 LR may be used on firing points 1-12 on the south side. No pistol calibers larger than.45 and no rifle calibers on pistol frames are allowed. If shooting a.44 magnum pistol, please use target loads. Heavier calibers damage our backstop. No steel, reactive, spinning, moving or other action targets are allowed unless under the direct supervision of a club-designated Range Safety Officer. Use paper targets only. The use of tin or aluminum cans or glass or plastic containers as targets is strictly prohibited. Do not place any kind of targets on the wood retaining wall on firing positions No fully automatic weapons allowed. No armor piercing or tracer ammunition allowed. I have received, read, and understand these safety, range, and administrative rules and agree to follow them. I understand that this form must be signed and turned in with my membership application. Member Signature Date Revised 04/16/15

5 ADMINISTRATIVE RULES The following administrative rules will assist us in operating our range safely: All members must sign in on the log sheet by the entrance door. Each member may bring no more than 2 guests during any visit. Members who allow others to use their access code will be suspended from membership. Use of profane or obscene language in the club building is not acceptable. We re trying to make our club a comfortable place for all shooters. Respect one another. You are responsible for your property while using the Centralia Rifle Club facility. The Centralia Rifle Club and Junior Division assumes no responsibility for personal property of its members or guests. WHEN YOU ARE FINISHED USING THE RANGE, PLEASE CLEANUP FOR THE NEXT SHOOTER : Put used targets in the marked container. Put brass only in the container marked for it. Put all other trash into the trash cans. (Empty Trash cans, when nearly full, into the dumpster outside the building to the left). Turn out the range lights; Then make sure the entry door shuts and is locked from the outside as you leave. NOTE: For health reasons, no food or drink is allowed in the Rifle Club RANGE. Wash your hands and face with cold water after shooting or handling cartridges to avoid lead ingestion. I have received, read, and understand these safety, range, and administrative rules and agree to follow them. I understand that this form must be signed and turned in with my membership application. Member Signature Date Revised 04/16/2015(

6 RELEASE, INDEMNIFICATION AND ASSUMPTION OF RISK AGREEMENT READ THIS CAREFULLY BEFORE SIGNING I,, being years of age, in consideration of the furnishings of facilities, equipment, targets and/or services, including but not limited to instruction in marksmanship by the CENTRALIA RIFLE CLUB, a Washington notfor-profit corporation, (hereinafter referred to as the CLUB ) and the CITY OF CENTRALIA, a municipal corporation, (hereinafter referred to as the CITY ), agree on behalf of myself, my survivors, my heirs, or assignees to fully and forever release, discharge, indemnify and hold harmless the CLUB, and the CITY, their agents, servants and employees from any and all claims, damages, demands, rights of action or causes of action present or future, whether the same be known, anticipated or unanticipated, which result from or arising out of my use or intented use of the premises, facilities, equipment, services or functions or my participation in any activity on the premises of the CLUB, or the CITY, from my participation in marksmanship instruction or activities conducted by the CLUB, or for my participation in marksmanship instruction or other activities conducted by the CLUB. I further agree that this indemnification and hold harmless agreement shall apply even if my injuries were caused in whole or in parts by acts of negligence by the agents, servants or employees of the CLUB, or the CITY, as lessor. I further acknowledge that firearms are inherently dangerous, and that marksmanship activities poses hazards which can include injury from and loss of life. I agree that the CLUB and the CITY shall not be liable to me on account of any personal injury, death of property damage sustained by me in, or about, the CLUB, or as a result of any allegedly negligent acts or omissions to act on the part of CLUB, or the CITY, specifically including injuries caused in whole or in part by alleged acts of negligence by the agents, servants or employees of CLUB or the CITY. I HAVE READ THIS ENTIRE AGREEMENT and placed my initials beside each paragraph. Date: Signature Date: Witness Release Indemnification Agreement.doc