APPLICATION FOR MEMBERSHIP
NAME__________________________________________________________________________________
ADDRESS_______________________________________________________________________________
CITY___________________________ ZIP_______________________
STATE___________ PHONE ( )___________
DOB___/___/___ OCCUPATION______________
E-MAIL______________________ MEMBERSHIP TYPE_________
NRA member: yes___ no ____
SIGNATURE__________________________________
Will you accept the news letter via E-mail? Yes___ No____
Recommending Member (print and sign) ___________________________________________________
Initiation Fee(all but juniors) $35.00
Regular Membership $75.00 TOTAL DUE _________________
Family Membership $150.00
(Family = Father, Mother & children under 18)
Junior Membership $15.00 Have you been convicted of a
Senior Membership (55 and older) $50.00 Felony ____yes ______no
subject to background check
print this form -- fill it out and return it to Perch Point with a check for the correct amount.
This application must be accompanied by a signed HHA agreement
Perch Point Conservation Club
P.O. Box 230068
Fair Haven MI 48023
Questions: Call Cliff 810-531-1765 or e-mail cliffjahn@msn.com
NAME__________________________________________________________________________________
ADDRESS_______________________________________________________________________________
CITY___________________________ ZIP_______________________
STATE___________ PHONE ( )___________
DOB___/___/___ OCCUPATION______________
E-MAIL______________________ MEMBERSHIP TYPE_________
NRA member: yes___ no ____
SIGNATURE__________________________________
Will you accept the news letter via E-mail? Yes___ No____
Recommending Member (print and sign) ___________________________________________________
Initiation Fee(all but juniors) $35.00
Regular Membership $75.00 TOTAL DUE _________________
Family Membership $150.00
(Family = Father, Mother & children under 18)
Junior Membership $15.00 Have you been convicted of a
Senior Membership (55 and older) $50.00 Felony ____yes ______no
subject to background check
print this form -- fill it out and return it to Perch Point with a check for the correct amount.
This application must be accompanied by a signed HHA agreement
Perch Point Conservation Club
P.O. Box 230068
Fair Haven MI 48023
Questions: Call Cliff 810-531-1765 or e-mail cliffjahn@msn.com
HHA AGREEMENT
Perch Point Conservation Club
Hold harmless release and indemnification agreement.
In consideration of being given the permission and the privilege to observe and or participate in the Perch Point
Conservation Club’s activities, I agree to sign and enter into this release and indemnification agreement.
I understand that I may participate in any and all of the following activities:
Archery and or Elevated Archery Shooting.
Shotgun shooting (Trap, Sporting Clays, and any other shotgun shooting sport taking place)
Rifle and pistol shooting.
BB-Gun and Air Rifle shooting.
I am entering this agreement freely, voluntarily, knowingly and state that:
I am not dazed, suffering from shock or under the influence of drugs or Alcohol.
I understand that this is a full and complete release indemnification agreement.
There has been no fraud or other conduct used in obtaining my signature and agreement to this document.
Participation Obligations:
I will comply with all rules and regulations.
If I have questions, I will immediately ask the nearest official or instructor.
If I observe any unusual or unnecessary hazard during my participation I will immediately bring such to the attention of
the nearest official or instructor.
I understand that the observation and or participation in the outdoor activities will expose me to certain risks inherent to
the use of firearms and related activities. These include but are not limited to personal injury, death and or personal
property damage. I agree to assume and accept the dangers inherent in the observation and or participation of the
shooting sporting and outdoor activities.
I represent that I can legally participate in and have no drug, health or mental problems that could or will interfere with
my observation and / or participation of the shooting, sporting and outdoor activities.
I agree that I am responsible for my own safety; however, if I’m rendered unconscious I agree to give my consent to the
R.S.O.’s to render aid to me and /or minors under my supervision.
Hold Harmless Release and Indemnification:
I agree to that Perch Point Conservation Club, it’s members, officers, directors, employees, agents, representatives,
affiliates, subsidiaries, succors or assignees and any participating groups and persons officially connected with the
activities will not be held liable if I suffer and personal or bodily injury, death or property damage as a result of ordinary
negligence.
I further agree that in the event that Perch Point Conservation Club, its members officers, directors, employees, agents,
representatives, affiliates, subsidiaries, successors or assignees and any participating groups and persons officially
connected with the activities become liable by way of contribution, indemnification, judgment, verdict award or otherwise
to any other party as a result of any actions, negligence, or injury. I agree to indemnify and hold harmless Perch Point
Conservation Club members, officers, directors employees, agents, representatives, affiliates, subsidiaries, successors
claims, demands, actual legal cost or other costs or expense arising out of said actions, negligence or injury, regardless
of the party choosing to bring such claim.
I have read the foregoing release and indemnification agreement and by signing, represent and warrant that I fully
understand it.
CAUTON READ BEFORE SIGNING
Print name:______________________________________________ Date _________________
Address: _____________________________
City _____________________________ State _____________ Zip _________________
____________________________________ _______________________________________
Signature Parent or Guardian Signature
Eighteen (18) Years old
___________________ _________ _____________ _________
_________________
E mail (optional) SHOTGUN RIFLES/PISTOL ARCHERY AIR RIFLE/BB GUN
All members of the Perch Point Conservation Club are required to have a signed Hold Harmless agreement on file at the
club. Please return this signed form to a board member or mail to Perch Point Conservation Club, P.O. Box 230068,
Fair Haven MI 48023
Perch Point Conservation Club
Hold harmless release and indemnification agreement.
In consideration of being given the permission and the privilege to observe and or participate in the Perch Point
Conservation Club’s activities, I agree to sign and enter into this release and indemnification agreement.
I understand that I may participate in any and all of the following activities:
Archery and or Elevated Archery Shooting.
Shotgun shooting (Trap, Sporting Clays, and any other shotgun shooting sport taking place)
Rifle and pistol shooting.
BB-Gun and Air Rifle shooting.
I am entering this agreement freely, voluntarily, knowingly and state that:
I am not dazed, suffering from shock or under the influence of drugs or Alcohol.
I understand that this is a full and complete release indemnification agreement.
There has been no fraud or other conduct used in obtaining my signature and agreement to this document.
Participation Obligations:
I will comply with all rules and regulations.
If I have questions, I will immediately ask the nearest official or instructor.
If I observe any unusual or unnecessary hazard during my participation I will immediately bring such to the attention of
the nearest official or instructor.
I understand that the observation and or participation in the outdoor activities will expose me to certain risks inherent to
the use of firearms and related activities. These include but are not limited to personal injury, death and or personal
property damage. I agree to assume and accept the dangers inherent in the observation and or participation of the
shooting sporting and outdoor activities.
I represent that I can legally participate in and have no drug, health or mental problems that could or will interfere with
my observation and / or participation of the shooting, sporting and outdoor activities.
I agree that I am responsible for my own safety; however, if I’m rendered unconscious I agree to give my consent to the
R.S.O.’s to render aid to me and /or minors under my supervision.
Hold Harmless Release and Indemnification:
I agree to that Perch Point Conservation Club, it’s members, officers, directors, employees, agents, representatives,
affiliates, subsidiaries, succors or assignees and any participating groups and persons officially connected with the
activities will not be held liable if I suffer and personal or bodily injury, death or property damage as a result of ordinary
negligence.
I further agree that in the event that Perch Point Conservation Club, its members officers, directors, employees, agents,
representatives, affiliates, subsidiaries, successors or assignees and any participating groups and persons officially
connected with the activities become liable by way of contribution, indemnification, judgment, verdict award or otherwise
to any other party as a result of any actions, negligence, or injury. I agree to indemnify and hold harmless Perch Point
Conservation Club members, officers, directors employees, agents, representatives, affiliates, subsidiaries, successors
claims, demands, actual legal cost or other costs or expense arising out of said actions, negligence or injury, regardless
of the party choosing to bring such claim.
I have read the foregoing release and indemnification agreement and by signing, represent and warrant that I fully
understand it.
CAUTON READ BEFORE SIGNING
Print name:______________________________________________ Date _________________
Address: _____________________________
City _____________________________ State _____________ Zip _________________
____________________________________ _______________________________________
Signature Parent or Guardian Signature
Eighteen (18) Years old
___________________ _________ _____________ _________
_________________
E mail (optional) SHOTGUN RIFLES/PISTOL ARCHERY AIR RIFLE/BB GUN
All members of the Perch Point Conservation Club are required to have a signed Hold Harmless agreement on file at the
club. Please return this signed form to a board member or mail to Perch Point Conservation Club, P.O. Box 230068,
Fair Haven MI 48023