APS Civil Defense Service

Name*

First NameLast Name

DoB*

Date

Gender? |Male/Female|*

Phone Number*

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Education*

Personal*

Citizen of the United States?

Currently employed?*

Employer/Company Name

Military or Law Enforcement History*

Military Service?

Branch

Status

Military Service

RetiredDischarged

Law Enforcement Service*

Status/ Department

RetiredDischarged

Criminal History*

If Yes. Criminal History

Which unit is closest to you*

If there is not a unit nearby, Select one of the two "remote" options in the next question.

Membership desired in APS*

Remote status is limited (AD), (RD), (FL), (PA), and (IT) only!

What is your general availability? (Does not need to be exact.)*

Rows	Free	Sometimes Free	Occupied
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

Statement*

IN CONSIDERATION OF the risk of injury that exists while participating in AMERICAN PATRIOTS SOCIETY (hereinafter the "Activity"); and
IN CONSIDERATION OF my desire to participate in said Activity and being given the right to
participate in same;
I HEREBY, for myself, my heirs, executors, administrators, assigns, or personal representatives
(hereinafter collectively, "Releasor," "I" or "me", which terms shall also include Releasor's
parents or guardian if Releasor is under 18 years of age), knowingly and voluntarily enter into
this WAIVER AND RELEASE OF LIABILITY and hereby waive any and all rights, claims or
causes of action of any kind arising out of my participation in the Activity; and I HEREBY release and forever discharge AMERICAN PATRIOTS SOCIETY, located at 7622 Gentle Bend Dr, San Antonio, Texas 78250, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns (collectively "Releases"), from any physical or psychological injury that I may suffer as a direct
result of my participation in the aforementioned Activity.

I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I
AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK I AM AWARE OF
THE RISKS ASSOCIATED WITH PARTICIPATING IN THIS ACTIVITY, WHICH MAY
INCLUDE, BUT ARE NOT LIMITED TO: PHYSICAL OR PSYCHOLOGICAL INJURY,
PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT
DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND
DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM
MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL TO AND
FROM THE ACTIVITY, OR FROM CONDITIONS AT THE ACTIVITY LOCATION(S).
NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN AND UNKNOWN TO
ME, OF MY PARTICIPATION IN THIS ACTIVITY.
I FURTHER AGREE to indemnify, defend and hold harmless the Releasees against any and all
claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise
brought by me or anyone on my behalf, including attorney's fees and any related costs.
I FURTHER ACKNOWLEDGE that Releases are not responsible for errors, omissions, acts, or
failures to act of any party or entity conducting a specific event or activity on behalf of Releases.
In the event that I should require medical care or treatment, I authorize AMERICAN PATRIOTS
SOCIETY to provide all emergency medical care deemed necessary, including but not limited to,
first aid, CPR, the use of AEDs, emergency medical transport, and sharing of medical information with medical personnel. I further agree to assume all costs involved and agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance.
I FURTHER ACKNOWLEDGE that this Activity may involve a test of a person's physical and
mental limits and may carry with it the potential for death, serious injury, and property loss. I agree not to participate in the activity unless I am medically able and properly trained, and I
agree to abide by the decision of the AMERICAN PATRIOTS SOCIETY official or agent, regarding my approval to participate in the Activity.

I HEREBY ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AMERICAN PATRIOTS SOCIETY AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS
AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST AMERICAN PATRIOTS SOCIETY FOR RIGHT THAT I OTHERWISE HAVE '10 HICLNG A LEGAL ACTION AGAINST AMERICAN
PATRIOTS SOCIETY FOR PERSONAL INJURY OR PROPERTY DAMAGE.
To the extent that statute or case law does not prohibit releases for ordinary negligence, this
release is also for such negligence on the part of AMERICAN PATRIOTS SOCIETY, its agents,
and employees.
I agree that this Release shall be governed for all purposes by Texas law, without regard to any
conflict of law principles. This Release supersedes any and all previous oral or written promises
or other agreements.
In the event that any damage to equipment or facilities occurs as a result of my or my family's or
my agent's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for
any and all costs associated with any such actions of neglect or recklessness.
THIS WAIVER AND RELEASE OF LIABILITY SHALL REMAIN IN EFFECT FOR THE
DURATION OF MY PARTICIPATION IN THE ACTIVITY, DURING THIS INITIAL AND
ALL SUBSEQUENT EVENTS OF PARTICIPATION.
THIS AGREEMENT was entered into at arm's-length, without duress or coercion, and is to be
interpreted as an agreement between two parties of equal bargaining strength. Both Participant and AMERICAN PATRIOTS SOCIETY agree that this agreement is clear and unambiguous as
to its terms, and that no other evidence shall be used or admitted to alter or explain the terms of
this agreement, but that it will be interpreted based on the language in accordance with the
purposes for which it is entered into.
In the event that any provision contained within this Release of Liability shall be deemed to be
severable or invalid, or if any term, condition, phrase, or portion of this agreement shall be
determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and
enforceable, then said provision shall be deemed to be written, construed, and enforced as so
limited.

I, THE UNDERSIGNED PARTICIPANT, AFFIRM THAT I AM OF THE AGE OF 18 YEARS
OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I
HAVING READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND
THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A
RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY
OWN FREE WILL.

PHOTO RELEASE 
For good and valuable consideration, the receipt of which is hereby acknowledged, I hereby grant American Patriots Society permission to use my likeness in a photograph in any and all of its publications, including but not limited to all of American Patriots Society's printed and digital publications. I understand and agree that any photograph using my likeness will become property of American Patriots Society and will not be returned. I acknowledge that since my participation with American Patriots Society is voluntary, I will receive no financial compensation. I hereby irrevocably authorize American Patriots Society
to edit, alter, copy, exhibit, publish or distribute this photo for purposes of publicizing American
Patriot Society's programs or for any other related, lawful purpose. In addition, I waive the right
to inspect or approve the finished product, including written or electronic copy, wherein my
likeness appears. Additionally, I waive any right to royalties or other compensation arising or
related to the use of the photograph. I hereby hold harmless and release and forever discharge
American Patriots Society from all claims, demands, and causes of action which I, my heirs,
representatives, executors, administrators, or any other persons acting on my behalf or on behalf
of my estate have or may have by reason of this authorization.

I acknowledge that singing in the box below I agree to the terms and conditions listed above.

Yes.

Yes

Applicant Signature*