41st O.V.I. / 28th
Membership Application
Membership Type: Individual ____ Family____
Impression Type: Military____ Civilian ____
Name: ________________________________________DoB: ______________
E-Mail: _______________________________________
Address: ______________________________________
______________________________________
Home Phone: (______) ____________________________
Cell Phone: (______)____________________________
(optional)
Family Member Names Date of Birth
1.
_______________________________________________________________
2.
_______________________________________________________________
3. _______________________________________________________________
4.
_______________________________________________________________
5.
_______________________________________________________________
Reenacting is an exciting, fun, and
educational hobby.
However,
due to the nature of what we do, there is a possibility
of injury at every
event, drill, and demonstration. The level of
physical
activity is high; we use black powder, which is highly
explosive; we
handle bayonets, cook over fires, and must endure
harsh
environmental conditions such as high & low temperatures,
rain, snow, mud, etc...
By signing below you are stating that you
understand the nature
and dangers of the
activities involved, and agree that you
voluntarily accept
those risks. Furthermore, if any of the above
mentioned persons
is a minor, the parent or legal guardian will
also sign to take
responsibility for the minor, and to allow for
emergency medical
treatment of the minor(s).
Member (print): __________________________________________
Signature: _______________________________________________
Date: ___________________
Member
(print):____________________________________________
Signature: _________________________________________________
Date: ___________________
(If member is under 18)
Parent/Guardian (print):
_________________________________________
Signature:
________________________________________________________
Date: ___________________
*Please save, edit and email to cplkasper
or save, print and mail to the recruiting officer