Firearms Instructor Waiver (2022)
Lee County Wildlife Club
Sanford, NC  

Sign in to Google to save your progress. Learn more
Date of Submission: *
MM
/
DD
/
YYYY
Email Address *
Full Legal Name: *
Mailing address (include Street, City, State and Zip) *
Home Phone (Enter N/A If you have no landline) *
Cell Phone  (Enter N/A If you have no cell phone) *
Emergency Contact Name and Phone Number *
General Acknowledgement of Firearms Instructor I, the undersigned Firearms Instructor, execute this form (the “Agreement”) and hereby acknowledge that inconsideration of my use of certain facilities owned/leased by the Lee County Wildlife Club, Inc., a North Carolina non-profit corporation (hereafter “LCWC”) for firearms training, I agree to indemnify and hold LCWC harmless, covenant not to sue LCWC, as well as waive and release any and all claims that may arise during, or as a consequence of, my use of such LCWC facilities. In consideration of these opportunities afforded me by LCWC, I agree to (1) abide by all LCWC Rules, Regulations and By-Laws duly adopted, from time to time, by the LCWC Board of Directors; (2) maintain a firearms instructor general and professional liability insurance policy with coverage of $1 million per occurrence and $2 million aggregate, having LCWC as a named insured; (3) require each and every student whose training involves the use of LCWC facilities execute a LCWC “Guest Waiver”, while promptly supplying copies to LCWC; (4) provide LCWC with copies of all my instructor certifications; (5) instruct only courses in which I have appropriate certifications; (6) fully and completely cooperate with LCWC range personnel, to include prompt compliance with their instructions; and (7) ensure that all students receiving instruction from me (a) are of legal age, (b) have no legal impediment to owning or possessing firearms, and (c)will only use the skills and/or knowledge gained in any of my courses for lawful purposes. Risk Acknowledgement, Indemnity, Release and Covenant Not To Sue I fully understand that, as a consequence of any and all stages of providing firearms instruction (“Activities”),either my students, third parties or I may suffer injury, and that certain injuries may result in death or permanent physical disability. In consideration of the opportunities afforded me by the LCWC through this agreement, I hereby assume all risks, known and unknown, associated with participation in such Activities including, but not limited to, any injuries resulting from firearms, archery equipment, other weapons, falls, contact with other participants, and the conditions of LCWC facilities and equipment, to include bodily injuries, permanent disabilities and death. To the fullest extent permitted by law, I hereby agree to indemnify and hold harmless and defend the LCWC, its employees, organizers, volunteers, directors, representatives, agents and/or officers, (a.k.a. the “Indemnified Parties) from and against any and all claims, losses, damages, expenses and other liabilities (including, but not limited to, court costs, expert witness fees and attorney’s fees) arising out of Firearms Instructor Agreement and/or resulting in whole or in part from my participation in such Activities. I for myself and anyone entitled to act on my behalf, including, but not limited to my heirs, assigns and successors, hereby RELEASE, WAIVE ANDFOREVER DISHARGE the Indemnified Parties from any and all claims, losses, damages, expenses and other liabilities of any kind arising out of my participation in Activities, even if such claims, losses, damages, expenses and/or other liabilities arise out of the negligence or carelessness on the part of any or all of the Indemnified Parties. Furthermore, I covenant not to sue and not to file any legal action, lawsuit or other petition for judicial determination of my rights with respect to claims I might otherwise have against the Indemnified Parties at anytime, other than for specific willfully tortious act(s) and, in such case, only with respect to the specific person(s)whose willfully tortious act(s) caused me damage. Media Release I hereby grant and convey to LCWC all right, title and interest I may have in any and all photographs, motion pictures, video recordings, and any other recordings made during or about the Activity, and LCWC shall have the right to exploit such recordings throughout the universe, an unlimited number of times, in perpetuity by any and all means and media, no known or hereafter invented. Medical Emergencies I hereby give permission to the LCWC, its employees, organizers, volunteers, directors, representatives, agents and/or officers (hereafter, “LCWC Parties”) to contact emergency services for help, whether or not the LCWC Parties have contacted my emergency contact, and give permission to a licensed physician or other licensed medical provider to provide proper treatment, including but not limited to hospitalization, injection, anesthesia and/or surgery. I hereby RELEASE, WAIVE AND FOREVER DISCHARGE the LCWC Parties from any and all claims, liabilities, causes of action, damages, demands, judgments, executions, liens and costs whatsoever in law or equity, including, without limitation, liability for death or bodily injuries to any person or damage to any property resulting from any (i) claims made against medical providers of emergency services under this authorization, or (ii) against the LCWC Parties for obtaining emergency medical services for me pursuant to this authorization and waiver. Venue/Jurisdiction/Construction/Severability This Agreement shall be governed and construed in accordance with the laws of the State of North Carolina, and any dispute that may later arise with respect to any term or provision of this Agreement shall be resolved in the General Court of Justice, Lee County, North Carolina, it being my clear intent to consent to such jurisdiction and venue. Should any portion of this Agreement require judicial interpretation, I agree that the Court or Tribunal construing the same shall not apply a presumption that terms hereof shall be more strictly construed against any one party by reason of the rule of construction that a document is to be more strictly construed against the party who prepared the document. If any provision of this Agreement is held to be invalid or unenforceable, all other provisions shall nevertheless continue in full force and effect. By signing this Agreement, I agree that I have read it, that I understand its contents, and that I act voluntarily in executing it.  By entering my name and/or initials below, I certify that the information provided in this application is true to the best of my knowledge. I also attest that I am not subject to any disqualifying factors. *
Required
By signing this Agreement, I agree that I have read it, that I understand its contents, and that I act voluntarily in executing it.   *
Required
By entering my name below, I certify that the information provided in this application is true to the best of my knowledge. I also attest that I am not subject to any disqualifying factors. *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy