Archery Ranges Qualification 2020 Archery Re-Qual Certifications Firstname Lastname Member No. Email Appt Date Appt Time RELEASE OF LIABILITY INDOOR, OUTDOOR AND CROSS BOW ARCHERY RANGES AUTHORIZATION I, do hereby state: I have read and fully understand all rules pertaining to the use of the Indoor/Outdoor Archery Ranges located at the Chester Rod and Gun Club (CRGC). I am familiar with the safety procedures and rules of safe bow and/or Cross Bow handling. I agree to abide by all Archery rules and regulations at CRGC; and, understand failure on my part to due so may result in revocation of all Archery privileges. I agree that my participation in this activity/event, or any other activity/event/contest conducted by CRGC, is purely voluntary and represents a possible hazard to me due to the use of archery and/or cross bow equipment in a sporting endeavor. I assume all risk freely and hold all persons and/or businesses associated with this or any other event/contest I may participate in at CRGC, to be blameless in case of injury and/or death during this or any other event/contest. By selecting the "I Accept" button, you are signing this Agreement electronically. You agree your electronic signature is the legal equivalent of your manual/handwritten signature on this Agreement. By selecting "I Accept" using any device, means or action, you consent to the legally binding terms and conditions of this Agreement. You further agree that your signature on this document (hereafter referred to as your "E-Signature") is as valid as if you signed the document in writing. You also agree that no certification authority or other third party verification is necessary to validate your eSignature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your eSignature or any resulting agreement between you and Chester Rod and Gun Club. Acceptance I Accept. Member eSignature Acceptance Date Indoor/Outdoor Archery RangesQualification Checklist Range Safety Officer must check-off each item below, check off Pass or Fail and sign form below. Verified 1 Instructor demonstrates and/or explains:proper use of lighting, (Indoor Archery Range only) ventilation and heating system and the sign in process.A/C in the main meeting room (Indoor Archery Range) may be turned on to a comfortable level (if necessary) during the warm weather months, but must be turned off prior to leaving the building.Clean-up process both indoors and on the outdoor ranges (remove all targets, balloons, etc. from indoor backstop and, all soda cans, water bottles, broken arrows etc., from the outdoor range). Verified 2 Member must demonstrate understanding that:When using the Indoor Archery Range, the Archer must sign in & sign out (Sign in sheets are located on the desk just to the left of the Boardroom office).When using the Outdoor Archery Range, the Archer must sign in & sign out (Sign in sheets are located on the fence just as you enter the Outdoor Archery Range). Verified 3 Member must demonstrate bow/range safety:Demonstrate general operation & safe handling of their bow (verbal only, do not nock arrow):Does not nock an arrow until they are on the firing line, ready to shoot, with the bow pointed down range (Indoor & Outdoor Ranges).Demonstrate proper draw & release technique (bows must be drawn level with the floor). Drawing by pointing at the ceiling & coming down on the target is strictly forbidden).Be able to place 3 out of 5 arrows within a full-sized target.Understand that if more than (1) shooter is using the range, the first Archer on the range is considered the Range Safety Officer & no one is allowed to go down range until the Range Safety Officer specifies that it is safe to go down range. (Indoor & Outdoor Ranges).Understand that if more than (1) shooter is present, all Archers must shoot from the same distance. Absolutely no staggered Firing Lines..Be mindful that when shooting from the 30-yard line (on the Indoor Range), that no other member is using the restroom. If the restroom is occupied, Archers must not have an arrow nocked until the range is safe.Understand the process for raising & lowering the sunscreens on the Outdoor Range.Understands that 3D targets cannot be placed directly in front of the existing permanent targets that are on the Outdoor Archery Range. Verified 4 Instructor explains equipment care:Members using 3D targets on the Outdoor Range are responsible for setting up & putting away targets & stands in the Cinder Block House located on the right-hand side as you enter the Archery Range. Targets must be locked up after every use.Instruct that Members are responsible for any damages or for leaving 3D targets on the Outdoor Range. Verified 5 The RO qualifying the Archer is responsible for going over the Range Rules (with the Member) for both Indoor & Outdoor Ranges including the Cross Bow area. RSO Attestations The undersigned club official has verified the above-named person is checked out in the safe use of Archery equipment.. The member is handed a copy of the Indoor/Outdoor Archery and Cross Bow Range Rules. The member is authorized to use the Indoor/Outdoor traditional, recurve and compound bow Archery Ranges. The member is authorized to use the Cross Bow Range. Qualification Bow Type Traditional Recurve Compound TR/RE/Compound Bow Pass Fail Standard Bow Qualified Date Cross Bow Pass Fail Cross Bow Qualified Date Qualification Type New Member Re-Qualification Sticker Issued Yes No Input into SK-Net Yes No RSO eSignature Abramovitch Arcoite Carney Gonthier Rose Torrisi Select Certifier's LASTNAME RSO Badge No. RSO Notes Submit If you are human, leave this field blank.