General Range Waiver

USS Academy LLC · Required for all range activities

Event / Visit Information

Date *

Event Attending or Organization

Personal Information

First Name *

Last Name *

State Issued ID Number *

Mobile Number *

Email *

Minor Permission (if applicable)

Complete only if giving permission for a minor to participate

Minor's First Name

Minor's Last Name

Minor's Date of Birth

By completing this section, you certify that you are the legal guardian and grant permission for the named minor to participate in this range activity under your supervision.

Signature

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First Name

Last Name

Date Signed

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