YUMA RIFLE AND PISTOL CLUB, LLC

Waiver

Yuma Rifle and Pistol Club, LLC - Participant Waiver 2012

1. I hereby voluntarily, discharge, waiver, and relinquish all actions or causes of action

for personal injury, property damages or wrongful death occurring to the undersigned

arising as a result of engaging in or being present at activities at the Adair Ranges’ High-

power Rifle, 1,000 Yard Range. ______Initial here when read

2. Hereby covenants not to sue and voluntarily releases, waivers, discharges and relinquishes

any action or causes of action, aforesaid, which may hereafter arise for himself/herself and

for his/her heirs, executors, administrators and assigns prosecute or present any claim for

personal injury, property damage or wrongful death against theYuma Rifle and Pistol Club, LLC

or any of its officers, members, agents, servants or employees for any of said causes of action,

whether the same shall arise by negligence of any of said persons or otherwise. IT IS THE

INTENTION OF THE UNDERSIGNED BY THIS INSTRUMENT, TO EXEMPT AND

RELIEVE THE YUMA RIFLE AND PISTOL CLUB, LLC OR ANY OF ITS OFFICERS,

MEMBERS, AGENTS, SERVANTS OR EMPLOYEES; INCLUDING VOLUNTEERS, FROM

LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH

CAUSED BY NEGLIGENCE. ______Initial here when read

3. Agrees that the foregoing release is intended to be a broad and inclusive as permitted by the

laws applicable and that of any portion thereof is held invalid, is in that the balance shall,

notwithstanding, continue in full legal force and effect. ______ Initial here when read

    4. Acknowledges that the undersigned has been fully and completely advised of the potential for

    serious accident incidental to engaging in firearms activities, including the potential for death,

    personal injury and property damage, and expressly agrees to assume all risks of loss, damage

    or injury that may be sustained by the undersigned. ______Initial here when read

    5. This agreement shall remain in effect until December 31, 2012 and cancels all previous

    agreements. ______Initial here when read

6. The undersigned has read the foregoing paragraphs and voluntarily signs this agreement being

fully aware of legal consequences of signing the within instrument. ______Initial here when

read

I certify the above listed information is correct. I further certify that I can legally participate in the shooting sports as defined in Federal Laws, and I have not been convicted of a felony or misdemeanor which as a result of conviction precludes me from the ownership, transfer, and use of firearms or ammunition. I further agree to obey all rules and regulations, when if violated, may possibly result in arrest and conviction in Federal Court. Any misrepresentation may result in disbarment for a period of up to five (5) years.

DATE: ___________________ PRINT NAME: __________________________________________

(Participant or Guardian)

SIGNATURE: _____________________________________________

_____________________________________________ Date: ____________________

(Witness)

_____________________________________________ Date: ____________________

(Witness)

YRPC Form Participant Waiver for 2012

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