4th Texas

Name:

Address:

Home Phone Number:

City, State, Zip:

Work Phone Number:

Birth date:

Age:

Emergency Contact:

Type of Membership: (circle all that apply)

(New)    (Trial Membership, single event, one time only)    (Individual Membership)    (Family Membership)    (Other)

Number of persons in family membership:_____

If NEW application: Any previous reenacting?    (Yes)    (No)

If yes, name of Organization:

_____________________

Do you have any physical or medical conditions restricting your activities? (Yes )  ( No)

If yes, please describe:  

Email Address:

We recommend that you join the yahoo group ucwa_newsletter.

FOR MINOR APPLICANTS - Must Be Signed By Parent or Legal Guardian

 "I ,___________________________________, the Parent/Guardian of the above named minor, have read and understood the above statements and do hereby give permission for him/her to participate in all aspects of reenactment activities."

Signed _____________________________________ Date ____________________ Phone ( _______ ) _______________

Legal relationship to minor:

Safety reminders

This is not a complete list of Safety rules and regulations

1. Do not take a hit with a loaded firearm.

2. Do not fire your long arm at a distance closer than 30 feet.

3. At no time will ramrods be drawn on the field.

4. Paper cartridges will not be made with staples.

5. During battle scenarios, the carrying of pistols will only be allowed upon the approval of elected company officers.

6. The only wading used in pistols will be cream of wheat, cream of rice, corn meal, or farina.

7. Do not fire your pistol at a distance closer than 20 feet.

8. Bayonets will not be draw during battle scenario.

9 Do not point our firearm at any spectators.

10. Do not fire your weapon at a distance closer than 25 feet of a spectator.

11. If at any time a spectator enters the battle area, a cease-fire shall be called until the spectator is removed.

GENERAL RELEASE OF LIABILITY AND

AGREEMENT NOT TO SUE

Reenacting is dangerous, and the Utah Civil War Association, hereinafter referred to as UCWA, requires all participants and or parents of minor participants to assume all risk by signing a general release and agreement not to sue:

I acknowledge that reenacting, black powder shooting, and related activities are hazardous activities and that I have made a voluntary choice to participate in those activities, despite the risks that they may present.  In consideration of my being permitted to participate in the activities of the UCWA, I agree to assume ANY AND ALL RISKS OF INJURY AND DEATH which might be associated with or result from my participation in UCWA events or activities.  Such risks of injury or death may be caused in whole or in part by: burns; cuts; terrain conditions; heat prostration and related conditions; gun powder explosions; impacts from debris, accoutrements, vehicles and/or weaponry; the failure to follow command orders, and rules and regulations of the UCWA, rescue efforts, or medical attention provided by anyone connected with the UCWA; cardiac conditions; falls; or contact with animals.  (NOTE: this is not a list of all hazardous activities related to civil war reenacting and black powder shooting.  Accordingly, even if injury or death is caused by some risk or hazard not listed above, I still agree to assume any and all risk of injury and death which might be associated with or result from my participation in UCWA events and activities.)

 Initial Here ______

I further release, waive, discharge, and covenant not to sue the UCWA, the organizers of any UCWA event, the trustees of, officers of, agents of, or members of the UCWA, or any owner or lessor of any property on which the UCWA conducts any activity from all liability myself, or any party claiming an interest through myself, for all loss or damage or demand therefore on account of injury to the person or property or death of myself, whether caused by their negligence or for any other reason, while preparing for, practicing for, traveling to or from, or participating in any UCWA event.

 Initial Here ______

 I further INDEMNIFY AND HOLD HARMLESS the parties released above and each of them from loss, liability, damage, or claim they may incur due to the presence of my actions during the UCWA activities whether caused by their negligence or otherwise.

Initial Here ______

 It is the intent of the undersigned that the above Release be as broad and inclusive as allowed by law, and that if any portion be invalid, the remainder shall continue in full force and effect.  This Release is entered into solely for the benefit of the UCWA, its officers, trustees, agents, affiliations, and members when engaged in activities which promote the participation in the UCWA sanctioned activities, or the preparation for or travel to such activities, and does not confer a Release upon parties not acting in such a capacity.

 Initial Here ______

 I, the undersigned, have read and understood this Release and all its terms.  I warrant that the above is true and correct in all respects and that no representations, statements, or inducements apart from the foregoing have been made.  I consent to whatever medical care might be provided or available for injury occurring during the above activities.

 Printed Name: _________________________________     Signature: __________________________________  Date: _______________________

Membership Fee

Approvals

Individual. . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . $15.00

The following are required for all new applications:

Unit Commander:

Family of Two (living in Same Household)  . . . .  . . . . . . . . . . . .$20.00

Brigade Commander:

FOR UCWA OFFICE USE ONLY

Date Received:

Amount Received: