Permission - Liabilty Statement

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					                              OHIO 4-H SHOOTING SPORTS
                       PARENT / GUARDIAN PERMISSION AND
                         LIABILITY RELEASE STATEMENT


I, the parent / guardian of _______________________________________________, hereinafter
referred to as the “Child”; approve the use of firearms, archery equipment, ammunition, and any
other related equipment by this Child as part of the Auglaize County 4H Shooting Sports “Club”.
 I am fully aware of the risks and hazards associated with said types of activities, including but not
limited to the risks as noted herein, and the Child does hereby elect to voluntarily participate in
said activities and to engage in said activities knowing that the activities may be hazardous to the
Child. I also agree to allow this Child to participate in any other extracurricular activities of the
Auglaize County 4H Shooting Sports Club deemed appropriate by the Club. It is my
understanding that strict rules of conduct by the Child are obligatory and good personal safety
habits are mandatory. The Club will attempt to encourage appropriate safety practices by all Club
participants, but cannot assume responsibility for any Child who does not comply.
I further agree to indemnify and hold harmless the volunteers and staff of the Ohio State
University Extension Service and the volunteers and advisors of the Auglaize County 4H
Shooting Sports Club from any loss, liability, damage or costs, including court costs and attorney's
fees, that may incur due to the participation of this Child in any Auglaize County 4H Shooting
Sports Club activity, whether caused by negligence of the Ohio State University Extension
Service, the Auglaize County 4H Shooting Sports Club or otherwise. I also understand that I will
be responsible for all medical costs associated with any injury sustained by this Child during any
Auglaize County 4H Shooting Sports Club activity.
I understand that this Child can be expelled from the program if he or she fails to follow
instructions and safety guidelines.


Signed: ________________________________ Relationship: _____________________


Date: _______________________




                                            REVISED 03/10/2010

				
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