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                                                                     
      $30.00                                             $40.00
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: Jim Birch 196 South Rosa St.  Richland Center, WI 53581
      
Single membership    $30.00                   (checks payable to RCAC)
          Family membership    $40.00   
Memberships included outdoor leagues