Liability Waiver and Release Form

CLAY HOLLOW LLCWAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT I UNDERSTAND THAT THERE ARE VARIOUS RISKS INVOLVED WITH MY PARTICIPATION IN SHOOTING ACTIVITIES AT CLAY HOLLOW LLC 4080 MIDDLE GLADDING ROAD MAGNOLIA, MS. 39652. I UNDERSTAND THAT THOSE RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES OR DEATH CAUSED BY THE FOLLOWING: GUNSHOT; THE NEGLIGENCE OF OTHER PARTICIPANTS IN THE VICINITY; FAULTY EQUIPMENT,FIREARMS OR AMMUNITION PROVIDED BY MYSELF OR TO OTHER PARTICIPANTS; LIGHTING CONDITIONS;WEATHER; EXCESSIVE NOISE; EXCESSIVE DISTANCE TO MEDICAL CARE FACILITIES; AND EXCESSIVE TRAFFIC ON ROUTES TO MEDICAL CARE FACILITIES. I AGREE THAT, PRIOR TO PARTICIPATING IN THESE ACTIVITIES, IWILL INSPECT FACILITIES AND EQUIPMENT AND, IF I BELIEVE ANY ARE UNSAFE, I WILL IMMEDIATELY ADVISE AN OFFICER OF THE RANGE.I AM FULLY AWARE OF RISKS AND HAZARDS CONNECTED WITH BEING ON THE PREMISES AND PARTICIPATING IN THESE TYPES OF ACTIVITIES, AND I AM FULLY AWARE THAT THERE MAY BE RISKS AND HAZARDS UNKNOWN TO ME CONNECTED WITH BEING ON THE PREMISES AND PARTICIPATING IN THESE TYPES OF ACTIVITIES, AND I HEREBY ELECT TO VOLUNTARILY ENTER UPON THE ABOVE NAMED PREMISES AND ENGAGE IN THESEACTIVITIES KNOWING THAT CONDITIONS MAY BECOME HAZARDOUS OR DANGEROUS TO ME AND MY PROPERTY. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISK OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY, INCLUDING DEATH, THAT MAY BE SUSTAINED BY ME, OR ANY LOSS OR DAMAGE TO PROPERTY OWNED BY ME, AS A RESULT OF MY PARTICIPATION IN THESE ACTIVITIES, WHETHER CAUSED BYTHE NEGLIGENCE OF MYSELF, OTHER PARTICIPANTS OR OTHERWISE.IN CONSIDERATION FOR RECEIVING PERMISSION TO PARTICIPATE IN THE ABOVE REFERENCED ACTIVITIES, IHEREBY ASSUME ALL RISKS ASSOCIATED WITH THESE SHOOTING ACTIVITIES AND SHALL INDEMNIFY, WAIVE,RELEASE, AND FOREVER DISCHARGE CLAY HOLLOW LLC OWNERS, MEMBERS, AND ANY OTHER INDIVIDUALS OR ENTITIES CONNECTED IN ANY WAY TO THE LLC FROM ANY AND ALL CLAIMS FOR DAMAGES, DEATH,PERSONAL INJURY OR PROPERTY DAMAGE AND LITIGATION COSTS/ATTORNEYS’ FEES, ARISING FROM OR CONTRIBUTED TO, IN WHOLE OR IN PART, BY ANY ACT, OMISSION, FAULT OR MISTAKE OF THE ABOVE-NAMED PERSONS OR ENTITIES AND THEIR EMPLOYEES OR AGENTS, RESULTING FROM THE ABOVE DESCRIBED SHOOTING ACTIVITIES. IT IS MY EXPRESS INTENT THAT THIS INFORMED CONSENT AND WAIVER OF LIABILITY SHALL BIND THE MEMBERS OF MY FAMILY AND SPOUSE, IF I AM ALIVE, AND MY HEIRS, ASSIGNS AND PERSONAL REPRESENTATIVE, IF I AM DECEASED, AND SHALL BE DEEMED AS A COMPLETE RELEASE, WAIVER,DISCHARGE AND COVENANT NOT TO SUE ANY INDIVIDUALS IN ANY WAY CONNECTED WITH THE AFOREMENTIONED RANGE.I CERTIFY THAT I AM PHYSICALLY ABLE AND HAVE NOT BEEN ADVISED AGAINST PARTICIPATION IN THESE TYPES OF ACTIVITIES BY A HEALTH PROFESSIONAL. I HEREBY AUTHORIZE EMERGENCY MEDICAL TREATMENT IN THE EVENT OF INJURY OR ILLNESS. I ALSO AUTHORIZE TRAINED HEALTH CARE PROVIDERS, INCLUDING, BUTNOT LIMITED TO PHYSICIANS, NURSES, NURSE PRACTITIONERS, AND HOSPITAL CORPSMEN TO ADMINISTER ROUTINE AND/OR EMERGENCY MEDICINES AND TREATMENTS, AS NEEDED.I CERTIFY THAT I HAVE READ ALL THE PROVISIONS OF THIS INFORMED CONSENT AND WAIVER OF LIABILITY FORM AND FULLY UNDERSTAND ALL OF THE SAME. IF ANY PROVISIONS CONTAINED IN THIS INFORMED CONSENT AND WAIVER OF LIABILITY FORM ARE HELD TO BE INVALID, VOID OR ILLEGAL BY ANY COURT OFCOMPETENT JURISDICTION, THE SAME SHALL BE DEEMED SEVERABLE FROM THE REMAINDER OF THIS INFORMED CONSENT AND WAIVER OF LIABILITY AGREEMENT FORM AND SHALL IN NO WAY AFFECT, IMPAIR OR INVALIDATE ANY OTHER PROVISION HEREIN CONTAINED IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT:A. I HAVE READ THE FOREGOING RELEASE, UNDERSTAND IT, AND SIGN IT VOLUNTARILY AS MY OWN FREE ACT AND DEED;B. NO ORAL REPRESENTATION, STATEMENTS OR INDUCEMENTS, APART FROM THE FOREGOING WRITTEN AGREEMENT, HAVE BEEN MADE;C. I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND FULLY COMPETENT OR I AM SIGNING ON BEHALF OF A MINOR AS THEIR PARENT OR LEGAL GUARDIAN; ANDD. I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.WITNESS MY SIGNATURE THIS ______DAY OF ________ 20______.PRINT NAME__________________________________PRINT NAME OF WITNESS____________________________________SIGNATURE OF PARTICIPANT__________________________ SIGNATURE OF WITNESS_____________________________________/_______/ 20______ _______/_______/ 20______.