I, _______________________________hereby authorize __________________________,
Parent or Guardian [print]
a certified instructor, or agent of the San Jose Zouaves Rifle
Club to obtain
the necessary medical or dental treatment and care by a licensed
medical care
provider in the event of injury to my minor child while participating
in
marksmanship training.
I understand that the range instructor or agent of the San Jose
Zouaves Rifle
Club will furnish a firearm (rifle) to _____________________________________
Child's name [print]
for the purpose of instruction in marksmanship training.
This will include
the proper handling, safety precautions and firing live ammunition
under close
supervision of an instructor or agent.
In the event that the minor child named above violates any range
rules or
regulations or demonstrates negligence in the handling of any firearm
the
child will be removed from the firing line and not allowed to continue
with
the marksmanship training for the remainder of the day. Repeated
violations
or negligence will result in dismissal from the San Jose Zouaves
Rifle Club
Junior Program.
I understand that club activities may be photographed from time
to time and
I agree to allow any photos in which my child may appear to be
used for
non-commercial club related publications.
I, __________________________________, have read and explained the
range rules
Parent/Guardian
[print]
to my child named above.
Date: ____________________________, _________________________
Parent/Guardian signature
Current date
_________________________________________________________________________
Address to include Zip Code
____________________________________________
Telephone where you can be contacted
Minors birth date: __________________
Please provide two alternate phone numbers of family members or
friends who we
can contact in the event we cannot reach a parent or guardian.
Name and phone number _______________________________________
Name and phone number _______________________________________