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Harrisburg Hunters' and Anglers' Association

BB Gun Riflemen Team

6611 Hunters Run Rd

Harrisburg, PA 17111

Program Director: Burt "Rusty" Stockton

Email:  hbgbbteam@gmail.com
Phone:  (717) 903-0496

2020-21 Registration Form

This form must be filled out completely. Your full name typed in the appropriate boxes will be your electronic signature. This form allows for information of one adult. Additional parents, adults bringing the shooter to practice, or other contacts who should be added to our notification system, should be listed in the Contact Information box. We will have varying levels of competition this year. Please select the appropriate interest level. If you are registering multiple children, please complete this form separately for EACH child. If you have questions regarding any part of this form, please send an email to pam@hhachamps.org.

New and Returning Shooter Registration
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Shooter's Information
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Shooter's Level of Interest
Has child taken a gun safety course before?
Has child ever shot a gun before? (If so, what type? Check all that apply.)
Does child have any special learning needs? (If so, discuss with Pam and she will arrange accommodations.)
A copy of shooter's birth certificate is needed for all matches.
Primary Adult's Information
Type of Number

Volunteers

Every shooter has a fully trained line coach with them on the firing line. We train you for this position. Are there any concerns you have with fulfilling this position?

Contact Information

We will be sending emails to the address you entered above. If there is anyone else who should be receiving team emails or text messages, please list their name, email, and phone number. Some competitions ask for both parents to be listed on the liability form. If there is a second parent, please list name, address, phone, and email. (Please use a comma [,] or semi-colon [;] instead of the enter key.)

Acknowledgements

Liability Release

I hereby state that my son or daughter has my expressed permission to participate in the Shooter’s Education Program located at Harrisburg Hunters’ and Anglers’ Association, on the required dates as scheduled by the Harrisburg Hunters’ and Anglers’ Association. In granting such expressed permission for the participation of my son or daughter, I hereby, forever, release and discharge the Harrisburg Hunters’ and Anglers’ Association, or its members, and any individual member of the club or any person acting on the behalf of the Harrisburg Hunters’ and Anglers’ Association for and from any and all liability, claims, demands, controversies, actions, and causes of actions on account of any injury, loss or other damage of every kind and nature caused by or resulting from any incident which would occur during the participation of my son or daughter in the aforementioned program. Additionally, I hereby expressly state that in granting permission for participation of my son or daughter in the aforementioned program, I hereby release the Harrisburg Hunters’ and Anglers’ Association or its members, and any individual member of the Harrisburg Hunters’ and Anglers’ Association, or any person acting on the behalf of the Club mentioned from liability arising out of any conduct and/or action of my child during the course of the aforementioned program. I hereby agree that this permission and release of liability, with all the promises contained herein, shall be legally binding upon me, as well as binding upon my child. (Type your full name in the block to acknowledge your agreement.)

Media Release

I hereby authorize Harrisburg Hunters’ and Anglers’ BB Gun Rifleman team and and their affiliated organizations to use my and/or my child(ren)’s name, photograph, and/or likeness in any advertising and social media without restriction. No compensation will be paid for this use. I hereby agree that this permission and release, with all the promises contained herein, shall be legally binding upon me, as well as binding upon my child. (Type your full name in the block to acknowledge your agreement.)

Fundraising Agreement

I understand that as a member of the Harrisburg Hunters’ and Anglers’ BB Gun Rifleman team, I will make an attempt to participate in all fundraisers. I understand that each shooter is requested to sell a minimum number of items for each fundraiser. If unable to participate in any one fundraiser, a buyout to the team in lieu of the monies that would have been raised may be required. I understand that these fundraisers assist in keeping the BB Gun Rifleman program free. (Type your full name in the block to acknowledge your agreement.)