Membership runs from January 1st December 31st
Please print clearly and complete all fields
DATE: ___ /___ / ___
Name: ________________________________
Additional names on family membership:_______________________________
_________________________________________________________________
Address: _______________________________
______________________________________
E-mail_________________________________ updates on special events and tournament scores.
Home Phone: ___________________________
Cell: __________________________________
CHECK ONE
Single membership Family membership
Insurance waiver must be signed by each person on the family Membership.
Emergency Contact Info. Please include one emergency contact
Name: _________________________________
Phone: ________________________________
I agree that the information on this Document is accurate to my knowledge and in no way falsified. I have read and agree to follow the
Membership rules set forth by the Richland Center Archery Club and its officers. I know that failure to follow the rules set forth by the Richland
Center Archery Club can result in my removal as a member.
Print Name: ______________________________
Signature ___________________________________Date__________________
INSURANCE LIABILITY WAIVER AND INDEMNIFICATION AGREEMENT
GENERAL RECREATION PROGRAMS
I FULLY RELEASE AND DISCHARGE RICHLAND CENTER ARCHERY CLUB AND ITS, DIRECTORS AND VOLUNTEERS FROM ANY AND ALL CLAIMS
OR DAMAGES, INCLUDING CLAIMS OR DAMAGES ARISING FROM INJURIES, DEATH OR PROPERTY DAMAGE, WHICH MAY ARISE OUT OF OR
OCCUR IN CONNECTION WITH MY USE OF THE RICHLAND CENTER ARCHERY CLUB FACILITIES THE PROGRAMS OFFERED BY RICHLAND
CENTER ARCHERY CLUB OR ALLEGEDLY CAUSED BY THE NEGLIGENCE OF RICHLAND CENTER ARCHERY CLUB EXCEPT FOR THOSE
RESULTING FROM THE INTENTIONAL OR RECKLESS ACTS OF THE OR RICHLAND CENTER ARCHERY CLUB ITS DIRECTORS AND VOLUNTEERS.
I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS RICHLAND CENTER ARCHERY CLUB AND ITS DIRECTORS, AND VOLUNTEERS FROM
ANY AND ALL CLAIMS OR DAMAGES, COSTS OR EXPENSES, INCURRED BY RICHLAND CENTER ARCHERY CLUB ITS DIRECTORS, AND
VOLUNTEERS WHICH RESULT FROM OR RELATE TO MY USE OF THE RICHLAND CENTER ARCHERY CLUB FACILITIES AND THE PROGRAMS
OFFERED BY RICHLAND CENTER ARCHERY CLUB EXCEPT FOR THOSE RESULTING FROM THE INTENTIONAL OR RECKLESS ACTS OF RICHLAND
CENTER ARCHERY CLUB OR ITS DIRECTORS AND VOLUNTEERS
Check Box to accept
I HAVE BEEN OFFERED THE OPPORTUNITY TO REJECT THE TERMS AND CONDITIONS OF THIS LIABILITY WAIVER AND INDEMNIFICATION
AGREEMENT; HOWEVER, I CHOOSE TO ACCEPT THE TERMS AND CONDITIONS OF THIS AGREEMENT AS THEY ARE, WITHOUT NEGOTIATION.
IN ADDITION TO MY PARTICIPATION IN GENERAL ACTIVITIES PROGRAMS, I ACKNOWLEDGE THAT CERTAIN RISKS APPLY WHEN USING
RICHLAND CENTER ARCHERY CLUB THE UNDERSIGNED HEREBY RECOGNIZES AND ACKNOWLEDGES THAT CERTAIN RISKS OF PHYSICAL
INJURY AND PROPERTY DAMAGE EXIST WHEN PARTICIPATING IN THE PROGRAMS OFFERED BY RICHLAND CENTER ARCHERY CLUB,
INCLUDING BUT NOT LIMITED DEATH OR SERIOUS INJURY OR FALLING WHILE PARTICPATING IN ALL ACTIVITIES OFFERED BY RICHLAND
CENTER ARCHERY CLUB. I AGREE TO RELEASE ALL CLAIMS OF INJURY OR DAMAGE TO OR FOR MYSELF OR MY CHILD/WARD ARISING
FROM THE NEGLIGENCE OF RICHLAND CENTER ARCHERY CLUB AND ANY OF ITS DIRECTORS, OFFICERS, OR VOLUNTEERS.
Print Name______________________________________________________________________
_________________________________________________________ _________________
Signature (Parent of Guardian if under 18 years) Date
Mail completed Form to: John Cler 465 East 8TH ST. Richland Center, WI 53581
Single membership $30.00 (checks payable to RCAC)
Family membership $40.00
Memberships included outdoor leagues
