Camp Creek Hunt Club

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Application for Membership

Camp Creek Hunt Club

105 Pine Valley Drive, Stanley, NC 28164

Brandon High, President

www.campcreekhuntclub.org

First Name_____________________________________ Last Name___________________________________ MI_____________ AGE_________________

Address______________________________________________________________ City______________________________ State_____________ Zip__________________

Home #________________________________ Cell #___________________________________ Email____________________________________________

Driver's License #_________________________________ State Issued___________ Date of Birth___________________ Hunting License #_____________________________

Occupation____________________________________________ Married Yes_____ No______ Spouse Name______________________________________

Have you ever been convicted of a game violation? Yes_____ No______ Please explain on the reverse side of this application

Have you ever been convicted of a felony? Yes______ No_______ Please explain on the reverse side of this application

DEPENDENT INFORMATION

List Spouse and all dependent children under the age of 19 who will be using club property. All members and dependents must have a valid club ID card on their person at all times while on property.

NAME RELATIONSHIP DATE OF BIRTH DRIVER'S LICENSE #

_________________________________________________________________________________________________________________________________________________

Vehicle Information and ATV Information:

"Primary" "Vehicle #2" "ATV #1" "ATV #2"

Make____________________________ Make________________________ Make_____________________ Make_____________________

Model___________________________ Model_______________________ Model_____________________ Model_____________________

Color____________________________ Color________________________ Color______________________ Color______________________

Plate #___________________________ Plate #_______________________ Serial #_____________________ Serial #____________________

Insured by:________________________ Insured by:____________________ Insured by:_________________________________________________________

I HAVE READ THE CLUB RULES AND UNDERSTAND THAT THE OFFICERS OF "CAMP CREEK HUNT CLUB" CAN VOID MY MEMBERSHIP FOR VIOLATIONS OF THE STATE OF SOUTH CAROLINA LAWS, CLUB RULES, AND UNSAFE HUNTING PRACTICES. ALSO, BY SIGNING ALLOWS "CAMP CREEK HUNT CLUB" OFFICERS TO DO A BACKGROUND CHECK AS NEEDED TO VERIFY THE ABOVE STATEMENTS.

Signed__________________________________________________________________ Date____________________________________________

Release and Waiver of Liability, Indemnity and Hold Harmless AGREEMENT

The above signed wish to use lands leased by "Camp Creek Hunt Club" , Camp Creek Hunt Club members, and it's officers for recreational purposes and recognize that such lands use used primarily for the business of timber production and that the undersigned is using such lands might be injured on their property, might be damaged either by negligent or non-negligent behavior of others including but not limited to "Camp Creek Hunt Club", Camp Creek Hunt Club members, and it's officers personally, leasers and or the property owners. In view of these facts the undersigned for valuable consideration the subsidiaries, agents, employees, contractors, invitees, licenses, and guests waive all claims against any of them and agree to indemnify and hold harmless from any and all liability here after arising on account of damage, injury, or death of the above signed and damage of injury to their property resulting from negligence of any person or otherwise during the use of the lands by the above signed for recreational purposes pursuant to a license of which this release and waiver of liability, indemnity and hold harmless agreement are a part.

The above signed specifically acknowledges that they have read and understand this document and the "Camp Creek Hunt Club Rules" and recognize that by signing it they release others (including but not limited to "Camp Creek Hunt Club", Camp Creek Hunt Club members, and it's officers personally, leasers and or property owners), waive their claims against them and agree to indemnify them and hold them harmless from their own negligence that might result in damage, injury, or death to the above signed or their property.

SIGNED___________________________________________________ DATE__________________________________