2024 Registration Form

First Name*

Last Name*

Your email*

Your phone number*

Full Mailing Address (include City, State, Zip):*

Agency you are representing (if any):

Release And Waiver of Liability, Assumption of Risk, and Indemnity Agreement

IN CONSIDERATION of being permitted to participate to any extent in the Jasper County Sheriff’s Office, October 13, 2023, Law Enforcement Officers and First Responder's Firearms Competition, which will include the loading and firing of handguns and other firearms with live ammunition (“Activities”) -- which I understand I would not be allowed to participate in except for my signing this agreement -- I and on behalf of my personal representatives, assigns, heirs and next of kin:

1. ACKNOWLEDGE, agree and represent that I understand the nature of the Activities and that I am qualified, in good health, and in proper physical condition to participate in such Activities. I further agree that if at any time I believe conditions to be unsafe, I will immediately discontinue further participation in the Activities. I assume full legal and financial responsibility for my participation in the Activities.

2. FULLY UNDERSTAND THAT (a) THE ACTIVITIES INVOLVE RISKS AND DANGERS OF SERIOUS BODILY INJURY, INCLUDING PERMANENT DISABILITY, PARALYSIS, AND DEATH (collectively “RISKS”); (b) these Risks may be caused by my own actions or inactions, the actions or inactions of other persons, or the conditions in which the Activities takes place; and (c) there may be OTHER RISK AND SOCIAL AND ECONOMIC LOSSES known or unknown to me or not readily foreseeable at this time. Nevertheless, I FULLY ACCEPT AND ASSUME ALL SUCH RISKS AND ALL RESPONSIBILITY FOR LOSSES, COSTS, AND DAMAGES that I incur as a result of my participation in the Activities.

3. HEREBY RELEASE, DISCHARGE, AND COVENANT NOT TO SUE THE Jasper County Sheriff’s Office, Jasper County, Carthage Police Department, City Of Carthage and/or any of the representatives, officers, directors, employees, agents, members, volunteers, successors and assigns, and any other participants in the Activities, as well as any sponsors, advertisers, and owners and lessor of premises on which the Activities take place (each considered one of the “PARTIES RELEASED”) FROM ALL INJURIES, LIABILITIES, CLAIMS, DEMANDS, LOSSES, OR DAMAGES ON MY ACCOUNT INCURRED IN CONNECTION WITH THE ACTIVITIES, INCLUDING THOSE CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE PARTIES RELEASED OR OTHERWISE, INCLUDING NEGLIGENT RESCUE OPERATIONS. I FURTHER AGREE that if, despite this agreement, I or anyone on my behalf makes a claim against any of the PARTIES RELEASED, I WILL INDEMNIFY, SAVE AND HOLD HARMLESS EACH OF THE PARTIES RELEASED from any such claim, lawsuit, attorney fees, litigation expense, loss, liability, penalty, fine, damages (whether compensatory, punitive or otherwise), and/or any other cost which may occur or arise as a result of such claim.

4. GRANT FULL PERMISSION to the PARTIES RELEASED, with no obligation to compensate me, to use my name, voice, statements, image, likeness, and/or actions, in addition to any photographs, videotapes, motion pictures, recordings, and/or other record of my performance in the Activities in perpetuity worldwide in any manner and in any and all media, whether now known or hereafter devised.

5. AGREE that any oral representation, inducement or statement that conflicts with this written AGREEMENT is null and void.

Statement of Understanding
I HAVE READ THIS AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND WITHOUT INDUCEMENT OR ASSURANCE OF ANY NATURE AND INTEND IT TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY AS EXPRESSED HEREIN ALLOWED BY LAW. I AGREE THAT IF ANY PORTION OF THIS AGREEMENT IS HELD TO BE INVALID, THE REMAINING PROVISIONS SHALL CONTINUE IN FULL FORCE AND EFFECT.

Do you agree to the above?
I Agree.

Course Rules and Safety

Shooter when transporting your weapon from your vehicle to the registration table it will be unloaded with no magazine in the weapon, the weapon will either be in your holster or in a carrying case. Magazines may be pre loaded in any configuration you like but maintained separate from your weapon.

1) This range will be a cold range (all weapons unloaded magazine separate from weapon), until directed to load at Stage 1. All weapons will be clear and in a holster or carrying case while behind the shooting line.

2) After each stage is completed the shooter will show weapon clear and make safe. The shooter will holster when moving between stages and await instructions at the next stage. Those shooters without holsters will utilize their carrying case to transport their weapon to the shooting line and to the next stage (table will be at each stage to hold excess gear).

3) Scores and penalties will be reviewed before moving to next stage.

4) Eye and ear protection must be worn at all times while past the Pavilion and while on the firing line.

5) All shooters will maintain 180 degree discipline while shooting.

6) Once Stage 5 is completed the shooter will show clear and make safe their weapon for the final time.

Do you agree to the rules and safety of the range?
I agree.

Divisions: There are two divisions. Division 1 uses iron sights, Division 2 uses optics. Each division requires a $25.00 entry fee. Please choose one or both divisions below.
Division 1
Division 2