Rifle Range Qualification 2020 Rifle Re-Qual Certifications Firstname * Lastname * Member No. * Email Appt Date Appt Time RELEASE OF LIABILITY OUTDOOR RIFLE RANGE AUTHORIZATION I, do hereby state: I have read and fully understand all rules pertaining to the use of the outdoor rifle range located at the Chester Rod and Gun Club (CRGC). I am familiar with the safety procedures and rules of safe firearm handling. I understand being a member of the CRGC is a privilege. I agree to abide by all rules and regulations at CRGC; and, understand failure on my part to due so may result in revocation of these 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 firearm 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 E-Signature, and that the lack of such certification or third party verification will not in any way affect the enforceability of your E-Signature or any resulting agreement between you and Chester Rod and Gun Club. Acceptance I Accept. Member eSignature Acceptance Date Outdoor Rifle Range Qualification Checklist Range Safety Officer must check-off each item below, check off Pass or Fail and sign form below. Verified 1 Instruct and demonstrate:cased rifle/shotgun coming and going to vehicle use eye, ear protection and ball cap within the range shooting areatypes of firearms used on this range maximum target size for the outdoor rifle range 1 lane for guests - your lane shotgun slugs clean-up process Verified 2 Member must demonstrate knowledge of: general operation of firearm (verbal only, do not load at this point) loading and unloading (verbal only, do not load at this point) position and operation of the firearm safety Verified 3 Member must demonstrate firearm/range safety: firearm must always be pointed in a safe direction. finger must not be within trigger guard until on target and ready to shoot. firearm must be open and unloaded on the firing line until ready to shoot. Verified 4 Member must demonstrate firing the firearm: Shot placement - first shot to see where the bullet landsscore hits on the target at 25 yards in a proper and safe manner with two re-loadsif firing is complete, firearm must be open and unloaded Verified 5 Member must understand on the outdoor range: the use of the RED FLASHING light and the ORANGE line on the cement pad maximum targets, size, placement and initial shot placement sweeping area before leaving Verified 6 Instruct members on the rules all must follow when shooting steel no steel core ammunition when shooting on steelno trace cartridges are allowed to be used on Club ranges RSO Attestations The undersigned club official has verified the above-named person is checked out in the use of firearms handling. The member is handed a copy of the outdoor rifle range rules. The member is authorized to use the outdoor rifle range. Qualification Type New Member Re-Qualification Outcome Pass Fail Sticker Issued Yes No Input into SK Net Yes No RSO eSignature abramovitch anderson armstrong begley brown campbell carney charest coffill del tufo denison fisher goetz hall hankey hunter johnston jones joyce koury laliberte litterer madden madea maher mckenna mulchahey o'connell o'neill prouty retzke rookey sverker taylor thompson torrisi treat welch Young Select Certifier's LASTNAME RSO Badge No. Date Qualified Update Certification If you are human, leave this field blank.