J_ € (V INDOOR 109 l$rru-rjrogsi EA6IE Glti, fA1166 Brl-r3Gszqf ';5f_31'* PISTOL AND RIFLE RANGE'AND GUN SHOP WOODFIELD TXIVE MACON, GA 31 2I O We * $e Eade Gun RaEe uuehome )ltxr o our neu facility. tlYe ralue )rq, 6 a custqner and are gdrg b md<e every effort b assure tlut your visits are a safe, deasanL ad fun experience for you d your friends ad family. Please cornptete this information *reet d read $e SAFETY RULES qr tfe hck. Please abir*e by these rules, they are for yon protection. DArE: €, }S - 1q CUSTOMER NUMBER (DRIVERS LICENSE): MME: ADDRESS: 't^ - srArEAa* l1t)h cIrY: ( L1gq, t'-r TELEPHONE: SHOOTING IIWERESI'S: 1 I certify that L am a legal rcsident of The t nited States of America, tlrt I hane never bcen corwicted of a felony crime or presently urder irdictment for same, ad will faithfulty cndeanor to fulffll the obligntions of gpod sportsmamlrip and safety. l, tte umden$gned ard affillated person (spoUse, family members, ersociate memberc), certify ttm l/we have read all tE M,i.lGE SAFETY RIX-ES rrd will conrply with $cm ad ttre by{auis of the EAGLE qI{ RANGE, lNC. lf at any Ume I sce rctions by other clrstomers that may:be unsafe or any eq$nent or structures that may be unsafe, I will inrmcdately brtrg ttrem to tfie attentim of the MI.IGE MASIER a MAiIAGER of the Eagb Gtsr Range or &rty. ln consideration of the m&ligned beiqg alloryed,to use the facilities of trc EAgf GLN RANGE, INC-, tle unfu;i$red docs hereby release, distharge, waive, hoH harmless, erd co\renrtt nd E sre EAf,.E Gltl RANGE, lNC., its officers, directors, or enrployees from any and all liability to tre undcrslgne4 tfu heirs, executors, administrators, successors, assigns, and next of kin, oJ the undensigned, for any loss, danagies, or injury, indrrdirqg death, to tle tndersigned's person or proparty, or for any other srseqlene b tte undersigrred arising from, o.rt of, or as a resutt of, tle rse of ttp facilitles of EAd-E.d,!tt RANGE, INC by the tnder:X$ed. The undcrsisrd further conscnts to ad authorizes all emeigencf'medical'tretment to &e rndensi,grred as may 'be deemed approprhte un&r existing circumstances at fu time.of,any'injury b &e trUcrslgneO, ard b transportthe unOerslgncd O tre nGarcst emergency medcal facility" by whatwer maars may bc deemed-ryproprirate under the circumstan-ces. The rndersi$rcd tu?ttrer colserftsrb the taking, maklng, or rccording of pictures, movics, vidcotapG, or other images of ttre undersigned's likeness or vo,icc in ani manni inddcntd to Urc-use of ttrc ftcilities of the EAd-E H.N RANGE, ad to the publishlng, br@easting, or,dsgla3l of suctr lilcencss or voice wtErcut any compensatidr ttrerofior for tlu same. TIME IN: TIME otJT: I..ATG NUMBER: BE CHARGED TO THE sT47 S, )fr^?soo f)rir- DAMAGE TO RANGE EQUIPMENT WLL CUSTOMER
