Gem City Gun Club



Gem City Gun Club

Range use request

Name of Organization: ___________________________________________________

Contact Person: _________________________________________________________

Telephone Number: ______________________________________________________

Mailing Address: ________________________________________________________

_________________________________________________________

_________________________________________________________

Billing Address if Different: ________________________________________________

________________________________________________

________________________________________________

Email Address: __________________________________________________________

Range Requested: R-8 (Rifle, Pistol, Shotgun, Automatic Firearms)

R7 Multi purpose Range

R-6 Handgun

R-5 Handgun

R-4 Handgun

R-3 Indoor Range

R-3 Indoor Range And Class Room

R-2 Rifle Range 100 / 200 yd.

R-1 Trap / Shotgun only

|Please return to: |

|Gem City Gun Club |

|P.O. Box 10533 |

|Erie Pa. 16514-0533 |

Dates requesting:

1st ______/______/______

2nd ______/______/______

3rd ______/______/______

Estimated Number of shooters

___________________

Liability Insurance Carrier: ______________________________________________

Liability Insurance Policy Number: _______________________________________

Effective From: ____/____/____ to ____/____/____

I have read and understand the accompanying range use rules and guidelines and agree to maintain adherence to these rules at all times while using the Gem City Gun Club Facilities.

Name: ______________________________________________________________

Signature: ___________________________________________________________

Date: ____/____/____

Attachments: 1) Gem City Gun Club Range usage rules and guidelines.

2) Site Map

|Do Not write in this area: Gem City Gun Club use only. |

|Indoor Range Fee $__________ |

|Outdoor Range Fee $ __________ |

|Fee per shooter $ __________ |

Gem City Gun Club

Range usage rules and guidelines:

1) A contact person shall be designated as responsible for:

a) Acquiring a key for use of the approved area or range no sooner than 5 days prior to reservation date and shall return said key no later than 5 days after scheduled use failure to do so will result in additional per day charges.

b) Cost of lost keys is paid for by user (re keying may be necessary)

c) Keys may not be loaned borrowed or transferred to any other person.

2) Reporting of any accidents at or damage to the Gem City Gun Club

a) The Gem City Gun Club Contact person Must be notified within 24 hours

b) A detailed written report of any accident at or damage to Gem City Gun Club within 7 calendar days of incident.

3) Mailing copy-notifying neighbors in advance of dim light firing.

4) A copy of range reservation confirmation will be kept on hand while approved areas are in use.

5) All N.R.A. rules shall be in effect and a range safety officer will be designated

6) Indoor facility no person will be closer than 30 feet from the steel backstop wire firing.

7) Cleaning of facility when done is the responsibility of user.

8) Ranges will only be used by those who have been approved to use it.

9) A copy of your Liability Insurance must be on file prior to range usage.

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