Paralympic Shooting Clinic
Learn to Shoot!
August 6, 2016
Introduction to Paralympic air rifle and archery
Hosted by: Urbana University Shooting Sports Club, Champaign County 4H Shooting Sports Club, Miami Valley Adapted Sports, Wright State Adapted Recreation
Sponsor: Champaign County Chapter, Whitetails Unlimited
Where: Wright State University Student Union, lower level recreation center
3640 Colonel Glenn Highway, Dayton, Ohio
When: Saturday, August 6, 2016, sign-in begins at 9:30 a.m.
Agenda:
9:30-10:00 a.m. Sign-in
10:00-12:00 Air rifle instruction (4H/NRA certified instructors)
12:00-1:00 p.m. Snacks provided
1:00-3:00 p.m. Archery instruction (4H/USAA certified instructors)
Cost: $10.00 Cost includes use of equipment, targets, and ammunition. Light lunch will be provided. Clinic will be held rain or shine. Note: Registration fees for cancellations after July 30 will be non-refundable. Class size is limited to first 25 registrants.
Contact: Ken McCabe (937) 869-3103 or via email at .
Registration Form
Name: ______
Address: ______
______
Phone: ______
Email: ______
Send advanced registration, signed waiver, and check (payable to Champaign County 4H Shooting Sports) before July 30, 2016, to:
Kenneth McCabe
Attn: Paralympic Shooting Clinic
5200 W US Hwy 36
Urbana, Ohio 43078
Minor Photo Release
I give The Ohio State University, Wright State University, and/or Urbana University permission to publish in print, electronic, or video format the likeness or image of my child taken on August 6, 2016. I release all claims against the Universities with respect to copyright ownership and publication including any claim for compensation related to use of the materials.
Minor's name______
Parent/guardian name______
Signature______Date______
+++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++++
Please provide a little information about yourself:
Archery I have onever shot before osome shooting experience. oexperienced shooter
Rifle/air rifle I have onever shot before osome shooting experience. oexperienced shooter
Age ______
Disability______
Other medical information we should be aware of ______
Wright State University
Campus Recreation
Release, Waiver of Liability
Assumption of Risk
The Wright State University Office of Campus Recreation (CREC) is committed to conducting the high adventure, recreation programs in a safe manner and holds the safety of participants in high regard. The CREC continually strives to reduce such risks and insists that all participants follow safety rules and instructions that are designed to protect the participants’ safety. However participants and parents/guardians of minors registering for programs must recognize that there is an inherent risk of injury when choosing to participate in outdoor adventure, recreational activities.
You are solely responsible for determining if you or your minor are physically fit/ or skilled for the activities contemplated by this agreement and that you have no known medical or physical condition which could interfere with the safety of other participants. It is always advisable, especially if the participant is pregnant, disabled in any way or recently suffered any illness, injury or impairment, to consult a physician before undertaking any physical activity. Wright State University carries no accident coverage on participants and the cost of medical attention and/or hospitalization will be the sole responsibility of the individual participant and/or their parent or guardian.
High Risk Activity- Warning of Risk
High-risk activities engage the physical, mental, and emotional resources of each participant. Despite careful and proper preparation, instruction, medical advice, conditioning and equipment, there is still a risk of serious injury when participating in any recreational activities. Not all hazards and dangers can be foreseen. Participants must understand that certain risks, dangers and injuries due to acts of God, inclement weather, equipment failure, and all other circumstances inherent to recreational activities exist. Participation in this activity presents this risk of physical injury, these injuries may be substantial and permanent, including but not limited to, fractures, muscle strains, sprains, bruises, and even in some circumstances paralysis and death.
Assumption of Risk
I hereby certify to Wright State University that I have no known medical problems or conditions, which would in any way prevent me from participating in this high adventure activity. I understand and voluntarily assume responsibility for any injury, loss, or damage resulting directly or indirectly from my participation in this activity including transportation to and from the below mentioned location where the event is being held and will not institute any negligence or other claim against Wright State University, the Campus Recreation staff, its agents, or any other persons who could be held liable either in their individual or official capacities. I agree to hold the above named parties harmless from any liability for any personal or property injury. I herby fully release and discharge Wright State University from any negligence or other claim for liability, loss, or damage. In addition I understand and agree that Wright State University and the CREC cannot be expected to control all of the risks articulated in this form, but may need to respond to accidents and potential emergency situations. Therefore, I hereby give my consent for any medical treatment that may be required during my participation with the understanding that the cost of such treatment will be my responsibility.
I have read and understand the foregoing statements and voluntarily sign this assumption of risk with full knowledge of its significance.
Signature ______Date ______
______Activity ______
Print full name
For Minors: If the participant is not yet eighteen (18) years old, the parent or guardian must sign the following:
I am the parent/guardian of the above minor child, and have full authority to authorize the above release which I have read and approved.
Parent’s Signature ______Date ______