Westport Fish and Game Club Membership Application

Westport Fish and Game Club Membership Application

Standard online membership application form. Use the extracted structure from the source document and keep all fields optional unless clearly marked as required. Ensure the Telephone field uses the Phone Number field type.
Applicant Information
Name

First NameMiddle NameLast Name
Mailing Address

Mailing Address

Mailing Address Line 2
CityState / ProvincePostal / Zip Code
Date of Birth

MonthDayYear
Date
Telephone
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Family Information
Total Number of Applicants (including self)
Spouse/Significant Other
Child 1 Age
Child Under 18 Name

First NameMiddle NameLast Name
Child 2 Name

First NameMiddle NameLast Name
Child 2 Age
Child 3 Name

First NameMiddle NameLast Name
Child 3 Age
Able to participate in club functions (fundraisers, events, cleanup, maintenance)
Participation and Membership
Able to attend regular monthly meetings (second Monday)
Membership Category
Application Certification
Printed Name (Application)
Signature (Application)
Date (Application)

MonthDayYear
Date
Liability Release and Waiver

Release of LiabilityREAD CAREFULLY BEFORE SIGNINGIn consideration of being allowed to participate in any way in the Westport Fish and Game Club’s programs, shooting range, and related events or activities, the undersigned acknowledges, appreciates, and agrees to the following:Assumption of RiskI understand that the risks of injury during participation are significant, including permanent paralysis and death. While proper skill, equipment, and discipline may reduce these risks, serious injury remains possible.Acceptance of RiskI knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the Club or others. I accept full responsibility for my participation.Compliance with Safety StandardsI agree to follow all stated and customary safety rules. If I observe an unusual or significant hazard, I will immediately bring it to the attention of Club Officers or Board Members and cease participation.Release of LiabilityOn behalf of myself, my heirs, assigns, and next of kin, I hereby release, indemnify, and hold harmless the Westport Fish and Game Club, its officers, board members, officials, agents, employees, and volunteers from any and all liabilities related to injury, disability, or death arising from negligence or otherwise, to the fullest extent permitted by law.I have read and understood this Release of Liability and Assumption of Risk Agreement. I voluntarily agree to its terms by signing below.
Participant’s Signature (Liability Release)
Date (Liability Release)

MonthDayYear
Date
Parent/Guardian Waiver for Minor Participants

If the participant is under 18 years of age, the parent or guardian must complete this section:I certify that I, as parent/guardian with legal responsibility for this participant, consent to the release of liability as stated above. On behalf of myself, my minor child, and our heirs, assigns, and next of kin, I release and hold harmless the Westport Fish and Game Club from all liabilities arising from my child’s participation, even if due to negligence.
Parent/Guardian Signature
Printed Name (Liability Release)
Printed Name(s) of Minor(s)
Date (Parent/Guardian Waiver)

MonthDayYear
Date
For Club Use Only
Code (For Club Use Only)
Approved (For Club Use Only)
Paid (For Club Use Only)
Total Number of Members (For Club Use Only)
Venmo or contact Kathy Supernault at Westportfgclub@yahoo.com or on Facebook: https://www.facebook.com/share/1E9f76kSUN/
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Westport Fish and Game Club Membership Application

Applicant Information

Family Information

Participation and Membership

Application Certification

Liability Release and Waiver

Parent/Guardian Waiver for Minor Participants

For Club Use Only

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