Area 5 Young Guns CampMiamisburg Sportsman’s Club, Miamisburg, OH August 22-23, 2015

Name____________________________________________________________ USPSA #_____________________ First Last

USPSA Division/Class_____________________ Yrs. competing_________ Shirt Size_____________(Open, Limited, Production, Revolver, Single Stack)

Address__________________________________________________ City__________________________________

State__________ ZIP____________ Email___________________________________________________________

Contact Phone______________________ Sex______________ Date of Birth__________________________ Must be 9 to 17 years old

Emergency Contact__________________________________ Phone __________________________________

Camp fee - $150(includes shirt)Mail Application, Waiver and Camp Fee to:

Rick Steele – Area 5 Director269 Wiley Road

Chillicothe, OH  45601

Participation Release and Agreement

In consideration of permission to participate in the USPSA Young Guns Camp in Miamisburg, Ohio,

August 22-23, 2015, I (please print your name) _____________________________________________________, do hereby release the United States Practical Shooting Association/IPSC, a non-profit corporation, the Miamisburg Sportsman’s Club, and its directors, agents, members, camp officials, officers, employees and servants and any other contributor, sponsor or affiliate from all liability which might arise from any loss, damage, injuries, or death which I may sustain, and any theft, unexplained disappearance, or damage which may befall any of my property while en route to, during, and en route from the camp. I further assume all responsibility for any guest that I may bring. I acknowledge that I am under the age of eighteen(18), my parent or guardian will sign release below and that I have previously participated in competitive shooting matches, and that I am aware of the risks and hazards inherent upon such events, including, but not limited to, accidental discharge of firearms and loss of property through misplacement or theft. I acknowledge that I have read and understand the USPSA rules of practical shooting, and I acknowledge the right of camp sponsors to terminate my participation immediately upon any failure of mine or of my guests to comply with all rules, regulations, and directions of the camp officials. I further state that I have read the foregoing participation agreement and release and freely enter into it on behalf of myself and my distributes, heirs, next of kin, executors, and administrators. By accepting this invitation to compete in the Area 5 Young Guns camp, I am authorizing USPSA to use any photographs taken of me during the camp in its promotional literature, advertising, and internet web site.

I have read the Participation Release and Agreement and further attest that I meet the qualifications for participation in the Young Guns camp. I will include a signed copy of the Consent for Possession of Handgun By Juvenile form with this invitation and will keep the original copy of the consent form in my possession while traveling to and participating in the Area 5 Young Guns camp. (Form can be found at http://www.uspsa.org/forms/Consent_For_Posession_Of_Handgun_By_Juvenile.pdf)

_____________________________________ ________________________________________ ________________________Participant Signature Parent/Guardian Date