Clays for Kids Tioga County Youth Shooter Registration

Youth Full Name

First NameMiddle NameLast Name

Age

Date of Birth

Date

Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Prior Participation

T-Shirt Size

Parent / Guardian Full Name

First NameMiddle NameLast Name

Relationship to Youth

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Mailing Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Relationship to Youth

Safety training and coach approval

Name of TIMQ coach or instructor, if known

Experience Level

Has the youth safely handled a shotgun before?

Gauge or Ammo Type

Will the youth bring their own shotgun?

Will the youth bring their own eye and ear protection?

Medical conditions, medications, mobility needs, sensory needs, or other support needs

Parent/Guardian Consent

By submitting this form, I confirm that I am the parent or legal guardian of the youth participant listed on this form. I give permission for my youth to participate in Clays for Kids Tioga County.

I understand that this event involves sporting clays, shotguns, ammunition, outdoor terrain, golf carts, and other normal risks associated with shooting sports and outdoor activities. I understand that all youth participants must follow safety rules, coach instructions, range rules, and event guidelines at all times.

I understand that failure to follow safety rules may result in removal from participation. I also understand that youth participants should be 12 years of age or older and must have completed safety training with This Is My Quest, Inc. or be approved by a TIMQ coach before participating.

Hold Harmless and Assumption of Risk Agreement

I understand that participation in Clays for Kids Tioga County involves inherent risks, including but not limited to risks associated with shooting sports, firearms, ammunition, clay targets, outdoor terrain, weather conditions, vehicles or golf carts, equipment, instruction, and the actions of other participants.

In consideration of my child being allowed to participate, I knowingly and voluntarily assume these risks on behalf of myself and my child.

I agree to release, waive, discharge, and hold harmless This Is My Quest, Inc., Maple Ridge Sporting Clays, their officers, directors, board members, employees, volunteers, instructors, coaches, representatives, property owners, sponsors, event partners, and affiliates from any and all claims, demands, losses, damages, injuries, liabilities, or causes of action arising out of or related to my child’s participation in Clays for Kids Tioga County, except where prohibited by law.

I understand that this agreement applies to participation before, during, and after the event, including instruction, shooting activities, travel around the course, use of facilities, and participation in event-related activities.

Signature

Clays for Kids Tioga County Youth Shooter Registration

Youth Participant Information

Parent or Guardian Information

Emergency Contact

Safety Training and Coach Approval

Shooting Experience

Medical and Support Information