BARBERTOWN SPORTSMEN’S CLUB, INC.
222 Kingwood Station Barbertown Road,
Frenchtown, NJ 08825
Barbertown Sportsmen’s Club, Inc. - Agreement, Release & Waiver of Liability
(1) I ACKNOWLEDGE, UNDERSTAND, DECLARE AND AGREE THAT:
(a) To the best of my knowledge, I am in good physical condition and have no disease or
injury that would be aggravated by participating in activities/events, WHICH MAY
INCLUDE BUT ARE NOT LIMITED TO PRACTICING ARCHERY, FIREARM USE, AND CAMPING, being attended.
(b) Participating or assisting others in participating in attended activities may involve
RISK OF INJURY TO ME, INCLUDING DEATH, LOSS OR DAMAGE TO ME OR MY PROPERTY,
or other consequences, which might result from my own actions, inaction or negligence
but also the actions, inaction or negligence of others, the rules of play, or the conditions
of the premises or of any equipment used;
(c) There may be OTHER RISKS not known or not reasonably foreseeable; and
understanding all of the above.
(2) I assume all of the above risks and release, waive, discharge, hold harmless,
indemnify and covenant not to sue Barbertown Sportsmen’s Club, Inc., its officers,
directors, agents, representatives, volunteers, coaches, trainers or any other individuals associated with Barbertown Sportsmen’s Club, Inc. I also release, waive, discharge, hold harmless and covenant not to sue the owners, lessors and lessees of the premises used to conduct the activities from ANY AND ALL LIABILITY FOR INJURY, INCLUDING
DEATH, LOSS OR DAMAGE TO PERSON OR PROPERTY, OR ANY OTHER CONSEQUENCE arising out of participation in, performance in or lack of performance
in the activities.
(a) I assume the responsibility and the condition of my own equipment and or injury to
others participating in activities attended at Barbertown Sportsmen’s Club, Inc.
(3) I FURTHER AGREE THAT:
(a) Prior to participating in activities, I, or in the case of a minor, a parent or guardian,
will INSPECT the facilities and equipment to be used, and if I believe same to be unsafe,
I will immediately REPORT such condition(s) to the supervisor or officer(s) and either
DECLINE TO PARTICIPATE or ASSUME THE RISK of participating:
(b) I will ALLOW my PHOTOGRAPH, PICTURE or LIKENESS and/or VOICE to
APPEAR in any documentary, promotional (including any and all advertisements),
television, radio, or film coverage of Barbertown Sportsmen’s Club, Inc. WITHOUT COMPENSATION.
(4) I CONSENT TO ALL EMERGENCY MEDICAL TREATMENT as may be deemed
appropriate under existing circumstances by medical personnel or personnel associated
with Barbertown Sportsmen’s Club, Inc.
I HAVE READ THIS FORM IN ITS ENTIRETY AND HAVE PROVIDED TRUTHFUL INFORMATION.
PARTICIPANT NAME (PRINT) (IF 18 OR OLDER) PARTICIPANT SIGNATURE DATE: ____________
Signature of Parent/Legal Guardian, individually and in the capacity as Parent/ Legal
Guardian is required if the Participant is under 18 years of age.
PARENT/LEGAL GUARDIAN NAME (Print) PARENT/LEGAL GUARDIAN SIGNATURE
ADDRESS CITY STATE ZIP CODE
PRIMARY PHONE E-MAIL ADDRESS