YHEC Registration

Participant Information

Participants's Name*

First NameLast Name

Participant Phone Number*

Please enter a valid phone number.

Participant email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Birth Date*

MonthDayYear

School Grade*

Hunter Education Card ID#*

Upload Copy of Hunter Education Card

Have you been a YHEC participant before?

YesNo

Parent/Guardian Information

Name*

First NameLast Name

Home Number

Cell Number

E-mail*

example@example.com

Emergency Information

Emergency Contact's Name*

First NameLast Name

Relationship*

Phone Number*

Alt. Phone Number

Does the participant have any allergies, chronic illness, or medical conditions? Please describe any medical condition that may require medication as a treatment, list all medications and/or allergies.

Immunization Information: Date of last Tetanus injection*

Informed Consent and Acknowledgment As Parent and/or Guardian of the named participant, I do hereby give my permission for my child to participate in the National Rifle Association's Youth Hunter Education Program and any/all practice sessions.

Parental Authorization for emergency medical care I hereby authorize you, in the event of an emergency, that is, when you are unable to reach me for authorization or when circumstances require immediate action, to proceed according to good medical practice with treatment of my daughter/son. Also, I authorize the hospital attending physician, or other healthcare specialist administering the treatment to release pertinent information to the insurance company assuming coverage for the same.

Primary Insurance Company Name*

Policy Number*

Medical Release and Authorization As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to the {Organization} . and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Assumption of Risk, Waiver, and Release In consideration of the allowed to participate in the NRA Youth Hunter Education program and the Jack O'Connor Hunting Heritage and Education Center, related events and activities, the undersigned appreciates, acknowledges, and agrees that:

1. There are risks of injury from participating in the activities involved in this program of events, including the potential of paralysis, disability, and even death. I knowingly and freely ASSUME ALL SUCH RISKS (known or unknown, present, future, direct, or consequential and whether physical, psychological, social, economic, or otherwise and including all treatment, hospitalization, or other care rendered to me in the event of my illness, injury, or emergent circumstances in the connection with my participation in the program of events) EVEN IF ARISING FROM THE NEGLIGENCE OF THE RELEASES of others, I assume full responsibility for my participation and all such risks.

2. I willingly agree to comply with the stated and customary terms and conditions for participation in this program of events. If I observe any unusual significant hazard during my participation, I will remove myself from participation and immediately bring such to the attention of the nearest staff/official member.

3. I, for myself, and behalf of my heirs, assigns, personal representative, and next of kin, HEREBY RELEASE AND HOLD HARMLESS the NRA Youth Hunter Education Challenge Program and the Jack O'Connor Hunting Heritage and Education Center, officers, committee National Governing Bodies, sponsors, advertiser, and if applicable, owners, lessors of premises used to conduct the program of events. ("Releases"), WITH RESPECT TO ANY AND ALL INJURY, PARALYSIS, DISABILITY, OR DEATH, and all liabilities, losses, claims and causes of action (including attorney's fees) and any nature, incurred, suffered or associated with the participation in the program of events, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASES OR OTHERWISE.

4. I hereby give my permission to the event organizers for the free use of my name, likeness and or pictures for use in broadcasts, telecast, newspaper, etc., for the promotion of the program of events.

5. I will follow and abide by the rules, policies, and code of conduct of the NRA Youth Hunter Education Challenge Program and the Jack O'Connor Hunting Heritage and Education Center. I HAVE READ THIS ASSUMPTION OF RISK WAIVER AND RELEASE AGREEMENT, AND FULLY UNDERSTAND ITS TERMS AND CONDITIONS AND SIGN IT VOLUNTARILY WITHOUT ANY INDUCEMENT.

Confirmation BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Parent or Guardian Signature*

YHEC reserves the right to terminate any participant from the program for repeated lack of attendance, flagrant safety violations, and behavior or attitude problems.

PARENTS ARE ALWAYS WELCOME AT ALL TRAINING SESSIONS

Today's Date

Date

REGISTRATION FEE: $25.00 (Payable to the Jack O'Connor Center)

Mail check to:

Jack O'Connor Center

P.O. Box 394

Lewiston, ID 83501

Youth Hunter Education Challenge Registration