Archers of Ravenwood 723 Springlake Pl. Escondido, CA 92027 760/ 480-6968

Membership Information

Name: ____________________________________	Emergency Contacts
Address: __________________________________	Name: _____________________________
City: _____________________________________	Phone No.: _________________________
State: _________ Zip Code: _________________	Relationship: ________________________
E-Mail: ___________________________________	Name: _____________________________
Date of Birth: _______________________________	Phone No.: _________________________
Gender: _____ SSN: ________________________	Relationship: ________________________
Home Ph#: ________________________________
Work Ph#: ________________________________
Stage Name: _______________________________

Medical Information About Which We Should Know: _________________________________

Waiver and Informed Consent to Participate

I, ______________________________________, (print Legal Name), having read and understood this document, freely consent to its provisions.

I am fully aware of the nature of the activities of the Archers of Ravenwood. I acknowledge that these activities are potentially dangerous, and voluntarily accept any risks involved. I agree to be bound by the rules and bylaws of the Archers of Ravenwood, and to obey the directions of the Board of Directors. Should any disputes arise from my participation in these activities, I agree to submit such disputes to the Board of Directors and to abide to the decision reached by said Board. I agree to release, hold harmless, and keep indemnified the Archers of Ravenwood and all its representatives from all Claims, Actions, Expenses, and Demands in such respect to Death, Injury, Loss or Damages to my person or property, however caused, arising in connection with my participation, even if the same may have been contributed to, or occasioned by the negligence of said body or any of its Representatives. This Waiver is binding to Myself, my Heirs, Executors, and Assigns.

_____________________________________________
Signature (Parent or Guardian if Minor)

_________________________________
Date

Notice: The information given on the following page is for the use of The Archers of Ravenwood only, and will not be given to individuals inside or outside the group without the written permission of the member covered in this document. By signing this document, you give the Archers of Ravenwood permission to use the information for the official records of the group. No members outside of the Board of Directors or Officers of the corporation are allowed to view this document without written permission of the individual covered within.