WAIVER OF LIABILITY-SPECDIVE TACTICAL, LLC Step 1 of 10 10% Name* First Last Date of Birth* MM slash DD slash YYYY Email* Enter Email Confirm Email Phone*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country NOTICE: The shooting of firearms (“Firearms Activity”) at SpecDive Tactical, LLC (SDT) is a HAZARDOUS AND POTENTIALLY DANGEROUS ACTIVITY. This agreement prevents you, your heirs, your family members, and legal representatives from recovering or bringing claim against SDT in the event of any injury or death for whatever reason, including and not limited to malfunction of a rented firearm or ammunition, negligence of an instructor, or malfeasance of a customer. This agreement is also meant to protect and release from liability all of the following (who are referred to with SDT as the “Released Parties”): officers, employees, instructors (whether employed or independent contractors), customers, members, attorneys, agents, lenders, suppliers, and all affiliated persons and organizations, INCLUDING SPECIFICALLY THE LANDLORD and its owners, officers, employees and affiliates, and all successors and assigns. In this agreement, we ask that you provide truthful answers to important questions. Failure to answer honestly may result in civil or criminal sanctions against you. VOLUNTARY PARTICIPATION*I verify that I am eighteen (18) years or older and I hereby state that I am voluntarily requesting to participate in Firearms Activity at SDT. YES NO ACKNOWLEDGEMENT AND ACCEPTANCE OF RISK ASSOCIATED WITH INHERENTLY DANGEROUS ACTIVITY*I understand that firearms activity is a dangerous activity in which, as a participant, I may suffer serious bodily, psychological and neurological injury or death, or cause injury to another person or property. Among the possible causes of serious injury or death, even if I am with an instructor are: A. Exploding or malfunctioning weapons and ammunition, even if rented/purchased from SDT B. Direct fire or ricochet of a bullet, either from my weapon, a rental weapon, or the weapon of an instructor or customer. C. Injury or death resulting from a slip, fall, collision, noise, or environmental condition, even if not directly caused by firearms, but while I am on the premises. I understand that injury or death could result from other causes not listed above, and that any event, which causes injury or death, is covered by this Agreement. YES NO I hereby agree to fully follow and comply with the instruction and direction of my instructors and range safety officers at all times. I further understand that any and all negligent firearm discharges, reckless conduct / behavior can be grounds for removal and dismissal from the course of instruction. Negligent conduct will result in forfeiture of any and all course fees at the discretion of the lead instructor. This negligence also may be subject to civil or criminal penalties, or both.*I hereby agree to fully follow and comply with the instruction and direction of my instructors and range safety officers at all times. I further understand that any and all negligent firearm discharges, reckless conduct / behavior can be grounds for removal and dismissal from the course of instruction. Negligent conduct will result in forfeiture of any and all course fees at the discretion of the lead instructor. This negligence also may be subject to civil or criminal penalties, or both. YES NO NO INSURANCE REQUIREMENT*I understand that there is no obligation of SDT or any Released Party to maintain insurance protecting me or any other person engaging in this dangerous activity at SDT. I agree it is not advisable for me to participate in this Firearms Activity if I do not have medical/hospitalization insurance. YES NO ASSUMPTION OF THE RISK*I am voluntarily participating in Firearms Activity with knowledge of the danger involved and agree to accept any and all risks of damage, injury, or death. YES NO SUITABILITY OF PARTICIPANT*I promise that I will not participate in Firearms Activity if: A. I am or will be under the influence of alcohol/drugs/medication during the activity B. I have pre-existing physical limitations or conditions which may be aggravated or harmed by the activity C. I do not fully understand or comprehend any rules, restrictions or directions given during the activity YES NO Are you pregnant and/ or nursing? (if yes, you may not enter the Range Area while this condition exists)* YES NO Are you on any medications which would impair your coordination or judgment? (if yes, you may not enter the Range Area)* YES NO Have you been convicted of a felony or act of domestic violence?* YES NO Are you on probation or is there any legal restriction which would prevent you from engaging in Firearms Activity?* YES NO DESCRIBE YOUR LEVEL OF FIREARMS EXPERIENCE (select one) Beginner less than 5 hours of live fire experience OR unable to remove jammed ammunition from weapon Intermediate Between 5 and 25 hours of live fire experience AND able to remove jammed ammunition from weapon Advanced More than 25 hours of live fire experience able to remove jammed ammunition from weapon Cancellation Policy*Cancellation made within 72 hours of class’s starting time will not be refunded. Agree RELEASE AND HOLD HARMLESS AGREEMENT*As consideration for permission by SDT to allow me to participate in Firearms Activities and use of facilities, I hereby agree that I, my heirs, legal representative, guardians and family members will not and cannot make a claim against, sue or attach the property of SDT, or any of the Released Parties or the supplier of any equipment used in the activities for injury, death or damage resulting from the negligence or other acts, howsoever caused. If a suit is brought by me or a representative I, or my estate, shall pay for the attorneys fees of SDT and any Released Party named in the law suit. I further agree and forever hold harmless and indemnify SDT and other Released Parties from any and all injuries and damages, resulting in any way from my participation or spectating in Firearms Activities, even if such damages are caused by SDT or any other Released Party through negligence or breach of any legal duty or standard of care. YES NO KNOWING AND VOLUNTARY EXECUTION*I have carefully read this contract and fully understand its content. I am aware this is a full release of liability and contract between myself and SDT and all Released Parties, and I sign it of my own free will. YES NO ONGOING EFFECT*This document may not be revoked, amended, or altered with respect to any occurrence or incident. It may be revoked prospectively (before an accident or occurrence which causes injury or death), but only if further participation in Firearms Activity at SDT stops, and provided further that written notice of the prospective revocation is provided to SDT and a written receipt is obtained from an SDT employee. YES NO INTERPRETATION*In the event that any court of competent jurisdiction determines that any provision herein is too broad, the Agreement shall be interpreted so that the provision is interpreted in a manner so as to maximize the protection intended for SDT and the Released Parties, and this Agreement, to the extent so modified, shall remain in full force and effect. YES NO SUCCESSORS*This Agreement is binding upon the successors and assigns of each Party and of all Released Parties. YES NO CHOICE OF LAW*This agreement shall be interpreted according to the laws of the Commonwealth of Virginia. YES NO IDENTIFICATION*I have produced the following form of identification AND CERTIFY THAT THE INFORMATION ON IT IS CORRECT: YES NO Participant Name* First Last Dated This Day:* MM slash DD slash YYYY Picture Identification* Military ID State Issued Driver's License State Issued ID Passport Driver's License (Issuing State & ID#) State Issued ID (Issuing State & ID#) Participant Phone*Participant Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Electronic Signature* I understand that typing my full name in this box constitutes a legal signature confirming that I acknowledge and agree to the Terms of Acceptance of the Waiver of Liability for SpecDive Tactical, LLC.EmailThis field is for validation purposes and should be left unchanged.
