HUMBLE ISD
CLAY TRAP
PROGRAM
Atascocita FFA
Humble FFA
Summer Creek FFA
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FFA CLAY TRAP
=====================================
**If you are interested in shooting Clay Trap with the FFA,
either for fun or in competition, sign up.
**You MUST:
1). Be an Atascocita, Humble, or Summer Creek FFA member in
good standing.
2). Retain academic eligibility according to district and UIL
regulations.
3). Have passed the Wildlife, Fisheries, and Ecology course to
compete in State FFA Competition.
4). Have passed the Texas Hunter Education Safety Course.
5). NOT have any Game/Fish Code violations or Penal Code
violations.
6). Attend scheduled practices at shooting range to compete. Dates
and times will be posted.
7). Provide your own ammunition- lead shot, 7 ½ ONLY.
8). Pay your own shoot fees at range. (if applicable)
9). Use appropriate and approved hearing protection and shooting
glasses when at practices and competitions. NO
EXCEPTIONS!!
**It is highly recommended that you shoot a shotgun that:
a. Fits you and has a very good recoil pad.
b. Is 12 gauge.
c. Is semiautomatic, as pumps and single shot shotguns kick a lot,
but it is up to you.
d. You use a shooting vest with a pad.
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Texas Ag Clays
Ag Science 381 Program
This new program introduces Clay Target Shooting to students who participate in “Wildlife, Fisheries and
Ecology.” (Ag 381 as it was formerly known) It is designed to enhance the “Recreation Management”
portion of this course by developing personal skills that may be carried on throughout a lifetime of
enjoyment of the outdoors. The Wildlife course curriculum has specific extracurricular time and this
shooting activity may apply as part of that time spent in the field.
During the past fifteen years, TPWD has participated in “youth shooting days” at several wildlife
management areas (e.g. Neasloney, Chaparral, Matador, Gene Howe, and Nails Creek). These events
provide opportunity for students to complete their hunter education course by participating in live-fire
exercises and hunter skills trail activities.
During these events, most students gravitate back to the shotgun area and want to continue to participate in
this specific activity. Numerous comments are made by students who ask, “Why don’t we do this
(shotgunning) as a team event?”
Many students, particularly young women, have stated beforehand, that they could not shoot a shotgun.
Yet, when they tried and succeeded, they were hooked and did not want to quit. These teenagers are
looking for an opportunity to continue shooting and develop new knowledge and skills, as well as
characteristics such as positive communication and self esteem. With this sport, students are continually
rewarded with “instant gratification” when they see that clay target turned into smoke and thus provides
instant feedback for their successful endeavors.
Included below is an overview of the Ag Clays Rules Summary.
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Open to all schools with Wildlife, Fisheries, and Ecology course
Open to all students currently enrolled (or previously enrolled) in Wildlife, Fisheries and Ecology
as long as they are still in school or graduated at mid-term, or will graduate in the current school
year. Graduates of previous years are ineligible.
Must complete Hunter Education certification before starting the Ag Clays program.
Must maintain UIL grade requirements. (no pass, no play)
Must be an SCHS FFA member in good standing
Zero tolerance for any Penal Code violation or Game/Fish Law violation.
Ag Clays starts with the game of trap, which is shot with a “squad” of five (5) individuals.
Competition will consist of shooting 4 rounds of 25 clays per round for a total of 100 clays; with
50 rounds on the field, a rest and then 50 rounds on another field.
Teams will consist of four (4) individuals.
The top three (3) individual scores will be used for overall team scoring.
Lowest scores will be dropped.
If team consists of only three (3) members, then all scores will be used.
Every attempt will be made to see that same school members shoot in the same squad.
If a team has less than four (4) members, individuals from other schools will make up the squad
and will shoot with that team.
Teams may be all-male, all-female, or mixed-gender.
Schools may only have one of each type of team per school.
Mixed-gender will consist of at least one member of the opposite gender.
If a school only has an all-male team and an all-female team, the mixed-gender team may be
comprised of members from both teams.
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The mixed-gender team members must be designated before competition begins.
Once any team is designated, no substitutions are allowed, and only the three (3) top scores will be
counted.
If a mixed-gender team consists of 3 males, 1 female the lowest male score is dropped.
If a mixed-gender team consists of 3 females and 1 male the lowest female score is dropped.
No limit to the number of individual students per school shooting for High Point Overall score.
There will be an “All-Male” and an “All-Female” division with High Point Overall award for each.
When only one or two individual(s) represent a school the individual(s) will compete for High
Point Overall award only.
Shotguns may not be larger than 12 gauge.
Students may use their own firearms if maintained in operable and safe condition.
Teams are responsible for supplies (i.e., eye and ear protection, ammo, clay birds, etc)
Saf-t-plug insert (provided by TPWD) should be used on al semi-auto and pump action shotguns
to show firearm is unloaded.
Teams are responsible for securing adequate ranges (public or private).
The Ag Clays State Shoot location and date will be announced in adequate time for preparation.
As the program grows, there may be designated “Regional Shoots” held prior to the state shoot.
Ag teacher/advisor must be a certified Hunter Education Instructor.
Team may be coached by someone other than the Ag Teacher.
Schools are encouraged to obtain sponsors and support for their teams through businesses,
organizations, and individuals.
Registration for the Ag Clays State Shoot will be determined according to location and target cost.
Amateur Trap Association rules will apply during shoot
o Squadding, Sec. IV, Rule G
o Shoot Offs, Sec. IV, Rule H
o Safety, Sec. IV, Rule I
o Scoring, Sec. VII, Rule A-E
o Standards, Sec. XIII, Rule A-F
o Ammunition, Sec. XIII
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Lesson Narrative
What is the game of Trap?
Trap is fun, fast paced game in which a shooter fires a shotgun at a four-inch diameter
saucer like object that is moving away from them. The target is made of biodegradable
material which will break when hit by the pellets. A machine called a trap throws the
targets, giving the game the name TRAP. A shooter may be interested in it for recreation
or may compete in organized shoots. The Grand American Trap Tournament held
annually in Sparta, IL is the largest organized trap competition with over 6,000 shooters
competing. The game of trap is a game where people of all kinds can participate.
History of Trap
In the early days of English shooting, live pigeons, rather than targets were used: that
may be the reason that clay targets are referred to as “birds”. Live birds were placed in
shallow holes in the ground covered or “trapped” with old hats attached to lines. At a
given signal (pull) the line was jerked and the pigeon took off in flight.
Interest in trap in the United States started some time early in the nineteenth century. The
first recorded trapshoot took place in Cincinnati, OH in 1831. In 1840, the Long Island,
New York Gun Club was created and the New York Sportsmen’s Club added
trapshooting to its program.
Charles Portluck of Boston was involved in influencing the movement away from livebird shooting in American. In 1866, he improved on a “sling device” used in England.
This “sling device” threw glass balls from a trap; this machine had many problems
though. Neither the in-flight pattern of the balls or the hardness of the glass was
consistent. Many modifications were made to the glass balls, feathers were glued to
some while others were filled with powder which, when hit, sent up a puff of smoke or a
flash.
In 1880 George Ligowsky of Cincinnati developed a flat-disc clay target, this target won
instant approval from the
trapshooting fraternity in England as well as in America. A year after the invention of
the clay target he produced an improved trap machine for throwing the clay targets, but
an Englishman named MCMaskey put the final touches on the target, creating what
became the target of today.
When the trap and clay targets finally arrived, interest in the sport of trap accelerated in
the 1890’s at an astounding rate. The first game of shooting clay targets involved five
traps set in a straight line. One person was prepared to shoot or “on deck,” positioned
opposite the center trap, and was allowed five shots. The shooter did not know which
target was being released, nor did he know the angle.
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W.G. Sargent of Joplin, Missouri, conceived the “Sargent System,” using three traps
instead of five. The traps, four feet apart, threw the targets at unknown angles to the
shooter. Within a year or two, the game was being played with one trap, five stations and
a squad of five shooters. This is known today as the game of TRAPSHOOTING.
Games of Trap
American Trap
The term “American Trap” is used to differentiate the sport from International or
Olympic Trap. It is referred to as “Trap”. Singles targets are thrown not less than 49
yards. Targets should be between 8 and 10 ft in height with the recommended height
being 9 ft. Singles targets are thrown at approximately 40 mph. A round of trap consists
of 25 shots or one box of shells. Shooting is done in rotation with the person in #1
position firing first. When each shooter has fired 5 shots from their station all move one
station to the right until each member of the squad has fired five shots from each of the
five stations.
Trap Range Layout
16-yard Line
The 16-yard line is the closet row of shooting positions on the trap field. It consists of
five shooting positions numbered from left to right when facing the trap house.
Handicap yard lines
Handicap yardage begins at the 18-yard line and extends to the 27-yard line. Handicap
yardage for new shooters are assigned in accordance with ATA rules. As they establish
ability by shooting high scores or winning handicap events, their yardage increases. By
assigning various handicap yardages to shooters based on their shooting ability, it is
possible to hold events where all shooters can compete on an even basis. Better
shooters are required to stand farther back from the trap house.
Puller/scorer
The puller has two purposed on the trap field: they release the target when the shooter
calls for the target and they score the result of the shot. At most ranges you will now
see automatic voice releases so the puller will only be scoring the result of the shot.
Once the target is release the puller/scorer becomes the judge of the shot.
Trap house and how to approach and enter it
Once it is necessary to go out to the trap house, many precautions must be taken. If the
purpose is to check the machine as a result of numerous broken and “no targets” be sure
all shooters on the field have opened and unloaded their guns. If skeet fields are
adjoining, do not get into the line of sight of the shooter on those fields. Before
entering the trap house be sure to put up the flag or something on the trap house roof to
let others know someone is in the house. Enter the trap house from either side, but do
not walk in front of the house. You will need to release the target and arm; once these
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are released you can then turn the machine off. When ready to turn on machine it’s
always a good idea to call “CLEAR” before turning power on.
Amateur Trapshooting Association (A.T.A)
The purpose of the A.T.A. is to promote and govern the sport of amateur trapshooting
throughout the world.
Membership is divided into two classes, both of which have full shooting rights and
privileges. The membership year is from September 1 – August 31.
Life members- Life memberships are issued for a charge of $500. Senior Life
memberships for those 65 years and older are $250 Life members are entitled to vote
for State Delegates and Alternate Delegates to the ATA. Only life members may hold
office at the A.T.A.
Annual members – pay annual due of $18, sub-juniors and junior memberships are
half-price. Annual members are entitled to vote for State Delegates and Alternate
Delegates to the A.T.A., but my not hold those or other offices in the A.T.A.
Shooting Gear and Attire
Eye protection
It is mandatory that everyone on the shooting field wears eye protection. This includes
shooters, coaches, pullers, scorers and spectators if they are close to the shooting line.
Eye protection doesn’t only protect yourself from mishaps with your gun/ammo it also
protects you from the other shooters mishaps. Eye protection will protect your eyes
from the gunpowder residue, which could be blown back into your face by the wind.
Ear protection
It is also mandatory that ear protection be worn by everyone on the shooting field as
well. Ear protection manufacturers put a “Noise Reduction Rating” on all packages of
ear protectors. The NRR is indicated in decibels ranging from the lowest protection of 0
to the highest of 30. There are many different types of ear protection ranging from the
popular inexpensive and disposable earplugs made of sponge-like material to the
individually molded earplugs. These are usually obtained from hearing aid specialists.
Another type of is known as “Sonic Ear Valves” They are flexible, rubber like and are
designed to fit anyone’s ears. Inside they contain a mechanical diaphragm, which is
activated by the noise level. The advantage is that low-level noise like talking is
audible by the blast of the shotgun is muffled.
Earmuffs can also be worn for ear protection. This type of protection covers the entire
ear and is lined with noise absorbing foam. Some shooters have problems with
earmuffs because with their heads on the stock, the upper edge of the stock hits the
lower part of the muff. Earmuffs also come in many different styles from the most
simple to the electronic ones operated by batteries.
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Headwear
Shooters don’t realize that a wide-brim hat or a baseball-style hat is a benefit in many
ways. Caps help to shield the eyes from the elements of the weather; they protect the
face from target pieces (more true for skeet shooting than trap). In winter a hat also help
retain body heat
Vest and Pouches
Shooting vests come in a variety of styles and prices. You can purchase vests anywhere
from $50-$200. Most shooting vest feature a shoulder pad and large pockets. The
shoulder pad can be made of leather or cloth backed with thin foam-rubber padding.
The main purpose of the shoulder pad is to prevent the gun from slipping and to help
with the guns recoil. They can be made of mesh trimmed with lightweight material or of
solid material. Shooting jackets/coats are also available in many different styles and
prices.
Shell pouches also range in style and price. The basic shell pouch should run about $15.
Shell pouches ride around the lower waist held in place over the hip with a belt. The
more expensive pouches maybe made from leather or suede and are divided into two
compartments. All clay target shooters should wear either a vest or shell pouch. This
makes access to your shells easy and if the shooter reloads they are able to keep their
hulls in the vest or pouch.
Footwear
When it comes to choosing the correct footwear for clay target shooting use common
sense. The footwear should have support and cushioning in the soles to reduce fatigue,
backaches and provide a stable shooting base. During the summer the shooter should
not wear sandals or deck shoes, as these will not give the shooter enough support. The
shooter should not go barefoot, as your feet will not be protected from the weather or
pieces of the clay targets. High-heeled shoes or boots are not conducive to good
shooting stance. Lifting the heel causes the legs to tilt forward, which will put the body
off balance.
Cold weather clothing
During the winter months it’s important to wear clothing that are warm and comfortable.
The clothing should allow for free movement of the arms and shoulders. A warm hat
should be worn to reduce the loose of body heat. A pair of warm boots will keep the
shooters feet warm and of course a thin pair of shooting gloves will keep their hands
warm. If the shooter is worried about their cold hands or feet they will not shoot well.
Try to avoid bulky, slippery clothing.
Shooting Gloves
The primary reason for shooting gloves is comfort and grip. Many shooters wear a thin,
golf or batting leather glove on the hand that holds the forearm of the gun, or sometimes
on both hands. When palms are sweaty, the finish on the gun can become slippery and
the thin leather glove improves the grip.
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Gunology
Chokes
Internally, shotgun barrels are more than just a tube. Beyond the chamber, the tube may
have a uniform diameter; but most shotguns have some constriction at the muzzle end
of the barrel. That construction is called a choke. The choke controls how fast the shot
will spread out after it leaves the muzzle. By keeping the shot in a more restricted area
(a tighter pattern), the density of the pattern is increased. Selecting the appropriate
choke for the types of shooting you are doing is part of learning to use a shotgun
effectively.
Listed in order of increasing amounts of constriction the standard chokes are: cylinder,
skeet, improved cylinder, modified, improved modified, full and extra full. A full or
extra full choke shotgun has the tightest construction and the greatest range. At closes
range a full choke pattern can be too small to consistently hit a moving target. The
modified choke will have a shorter effective range than a full, but a wider pattern at
close ranges. Improved cylinder choke is less constricted than the previous two and
give a wide pattern at close range.
Shot Patterns
Shot patterns are closely associated with chokes. The amount of choke affects the
spread or pattern of the shot. The pattern shot at 40 yards are used as a standard
measurement. To pattern a shotgun you shoot at a stationary target that will keep the
marks of the shot. This is usually done by shooting at a large paper target. The pellet
marks on the paper will tell if the gun is shooting where you are looking and if the gun
fits properly. A shotgun should be patterned before use and anytime any modifications
are made to it.
Patterning
To pattern a shotgun set a large piece of paper or cardboard (the piece should be 3’ x 3’)
40 yards from the shooting line. Place an “X” in the middle of the paper, as this will be
used as the aiming point. After firing, a 30” diameter circle is drawn to include the
greatest number of pellet holes. Disregard the “X”; it may or may not by in the center
of the circle. After counting the holes in the circle the number is compared to the
number of pellets known to in the shot shell used. This will tell you the pattern density
that your gun and ammo provided at 40 yards.
Porting
Porting is a process that cuts grooves or drilled holes near the end of the barrel. This
technique allows expanding powder gases to escape sideways or upwards from the
vents at the muzzle. The main function of porting is to reduce muzzles life or “jump”
which is important to help the gun recover smoothly for the second shot in doubles.
One drawback to porting is the noise of the gun is magnified.
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Sights
Shotgun sights are metal or plastic beads of various sizes and colors. Sights on a
shotgun are not as important as those on a rifle. In rifle shooting sights are used for
precise aiming, but in shot gunning the shooter is pointing the gun at the moving target
and should not be looking at the sights directly. Sights help prevent canting the gun and
can help in aligning the eye along the rib of the barrel. It the shooter’s eye is on the
same level as the front bead but above the second or middle bead it will cause him t
overshoot the target. The eye should be looking down the center of the barrel and just a
bit above the rib (just high enough to see the target)
Stocks
Trapshooters usually prefer stocks with a straighter or higher comb to those with more
drop because the shots are being fired at rising, going-away targets. With this type of
stock the gun will shoot slightly higher. For clay target shooting stocks should have a
rubber recoil pad that will ease the recoil and prevent the gun butt from slipping out of
the “the pocket.”
Fitting a shotgun
The fit of a shotgun is probably the most important part of the shooting games. If the
shotgun is not fit properly the shooter will become discouraged and will give up. Only
about 70% of shooters can adapt themselves to “off the rack” guns. A shotgun is
correctly fitted when it feels comfortable shooting it, and when no part of the gun
interferes with the shooter’s sight or swing. If the stock is too short the shooter will
lower his head to keep his check on the stock. If the stock is too long, the beginner will
hold their head too high. A long stock will place the gun butt farther out on the shoulder
or arm instead of in “the pocket” causing bruising.
To test the fit of a shotgun hold the unloaded gun in the “off-shoulder” position. Then,
with eyes closed, place the gun in the shooting position and open your eyes. If the gun
fits properly, you eye should be sighting down the top of the barrel in perfect shooting
position with the nose about an inch from the thumb.
To check for the correct drop at the comb the following test can be tried. With the gun
unloaded mount the gun to your shoulder make sure the butt is in “the pocket”. With
your finger off the trigger, have a friend stand directly in front of you; point the gun
barrel at their eye. If they see the pupil of your eye just as if it were resting on the back
of the rib or receiver, the comb of the gun is perfect. If the eye is partially or
completely hidden, less drop is needed.
Range Set-up for Teaching the Trap Drill
Before beginning the trap drill there are a few things that can be done to help the
students. You will need 5 clay targets of the same color and if you have left hand
shooters you’ll also need 3 different colored clay targets. Use the clay targets to mark
the appropriate hold points for each of the 5 stations. You can also place a piece of
scrap carpet at each station; this will allow the students to rest their muzzle between
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shots. Let the students hold the target hoop while setting the targets and have them
watch for the target distance in relationship to the stake.
Purpose of the drill
The following drill is to assist a shooter with “learning the site picture” of all possible
angles in trap. It utilizes repeated shots from a station with a locked trap and begins
with a straight-away target, and gradually works the student around to the hard extreme
angles.
Beginning the Trap Drill
Drill 1 – Hard Right Target
Set the trap to an extreme hard right target. Have the students’ line up one behind the
other on the lane of station 1. Let them look at a couple of targets. Explain the
mechanics and review the fundamentals of stance, hold point, and eye focus. First
student on the line takes five consecutive shots at the straight-away target.
REMEMBER THE BASICS – KNOWN TO THE UNKNOWN – SIMPLE TO
COMPLEX. Have the first shooter move over to stations 2 and bring the next shooter
up to station 1. Station 1 starts the cycle, now the shooter on Station 2 has a right edge
target. Let these two shooters complete the 5 shot cycle and move everyone one station
to the right. Always let the shooter on Station 1 start the cycle. Keep progressing to the
point that shooter 1 has competed five shots on Station 5 and keep the other students
progressing through the stations until the last shooter is on Station 5. Be cautious, as
there becomes fewer shooters, to make them pace themselves so they do not rush their
setup and shots.
Drill 2 – Hard Left Target
As in the previous drill, you reverse the scenario and set the machine to the extreme
hard left target. Start Shooter 1 on Station 5 and have them work to the left around to
Station 1. Station 5 is now the straight-away and Station 1 is the hard left
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HOLD POINTS
The general rule for hold points for right hand shooters Station 1; 6 inches in from left,
front corner of the house. Station 2 is halfway between the left corner and the center of
the trap house. Station 3 is just little to the right of center (don’t want to hold right over
center as you won’t see that straight away target come out of the trap house). Station 4 is
halfway between the center and the right front corner of the house and Station 5 would be
over the right-hand corner of the house. As the shooter becomes more experienced they
may wish to vary these hold points. The shooter must also consider how high to hold
their gun. A majority of trap shooters hold their guns about a foot above the house on
Station 1 and brings the hold point up slowly until they are about 18 inches about the
house at Station 3; slowly bring the hold point back down till the hold point is a foot
above the house on Station 5. Some shooters prefer to hold their gun’s front bead
directly along the front edge of the trap house (this is common among one-eyed shooters).
The general rule for hold points for left hand shooters are - Station 1; use the left, front corner of the house.
Station 2 is halfway between the left corner and the center of the trap house. Station 3 is just little to the left of
center (don’t want to hold right over center as you won’t see that straight away target come out of the trap
house). Station 4 is halfway between the center and the right front corner of the house and Station 5 would be 6
inches inside the right-hand corner of the house. As the shooter becomes more experienced they may wish to
vary these hold points.
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Information on FFA Clay Trap Program
1.
According to research shooting sports boost some of the lowest injury numbers of any sport. (see data from American Sports
Data, Inc.; National Safety Council, and National Shooting Sports Foundation)
2. There are multiple opportunities for students to earn scholarships through organizations that support the shooting sports like:
a. Friends of the National Rifle Association
b. Texas FFA
c. National Shooting Sports Foundation-NSSF
d. Amateur Trapshooting Association-ATA
3. Texas House Bill 1020 established shooting sports as an acceptable activity for high school students (see attached
documentation from Sec. of State).
4. The program is educationally sound and curriculum based, as it meets TEKS for the Wildlife, Fisheries and Ecology course
offered through agricultural education. (see TEKS 130.15.II.D.1 and 130.15.II.K.4 and 5).
5. Practices and competitions are held outside of school hours, off-campus, and state competition occurs after conclusion of the
school year (second week of June).
6. Safety is the number one priority of advisors and participants.
7. Firearms, ammunition and other ancillary supplies are not permitted on campus at anytime for any reason. Students sign an
agreement to this effect.
8. There is no direct funding required from the school. Students raise funds through sponsorships from local businesses,
families, and friends for competition expenses and practice fees.
9. There are several grant opportunities being researched by advisors that would off-set expenses associated with the activity.
10. Benefits of the program include:
a. Firearm safety
b. Scholarship
c. Self control
d. Teamwork
e. Non-discriminatory participation (as long as competition requirements are met by the student)
f. Enhanced field learning associated with curriculum
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SUMMER CREEK FFA
CONSENT TO BACKGROUND CHECK
Print Name:_______________________________________________________
(First)
(Middle)
(Last)
Former Name(s) and Dates Used: ___________________________________________
Current Address Since: ___________________________________________________
(Mo/Yr)
(Street)
(City)
(Zip/State)
Previous Address From: __________________________________________________
(Mo/Yr)
(Street)
(City)
(Zip/State)
Previous Address From: __________________________________________________
(Mo/Yr)
(Street)
(City)
(Zip/State)
Social Security Number: __________________________________________________
Date of Birth: ___________________________________________________________
Telephone Number: ______________________________________________________
Drivers License Number/State: _____________________________________________
The information contained in this application is correct to the best of my knowledge. I hereby authorize Summer Creek
FFA and Texas Parks and Wildlife and its designated agents and representatives to conduct a comprehensive review of
my background causing an investigative consumer report to be generated for team participation purposes. I understand
that the scope of the investigative consumer report may include, but is not limited to the following areas: verification of
social security number; current and previous residences; civil and criminal history records from any criminal justice agency
in any or all federal, state, county jurisdictions.
I further authorize any individual, company, firm, corporation, or public agency (including the Social Security
Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me, to
Summer Creek FFA and Texas Parks and Wildlife or its agents. I further authorize the complete release of any records
or data pertaining to me which the individual, company, firm, corporation, or public agency may have, to include
information or data received from other sources. I hereby release Summer Creek FFA and Texas Parks and Wildlife,
the Social Security Administration, and its agents, officials, representative, or assigned agencies, including officers,
employees, or related personnel both individually and collectively, from any and all liability for damages of whatever kind,
which may, at any time, result to me, my heirs, family, or associates because of compliance with this authorization and
request to release.
Student Signature: __________________________
Parent Signature: ___________________________
4-H Shooting Sports Guide
Date: _____________
Date: _____________
19
STUDENT EMERGENCY CONTACT INFORMATION
FFA CLAY TRAP
=======================================
Student Name:______________________ Home Phone:______________
Age:________ Address:______________________________________
Street
City
Zip
Parent/Guardian Name:_______________________________________
Last
First
Parent Guardian Cell Number:__________________________________
Parent/Guardian Name:_______________________________________
Last
First
Parent Guardian Cell Number:__________________________________
Father’s Employer: ______________________ Phone:______________
Mother’s Employer: ______________________ Phone:______________
Name of Person to contact if parent/guardian is unavailable:
_________________________________________________________
Name
Relationship
Phone
Name of Person to contact if parent/guardian is unavailable:
_________________________________________________________
Name
Relationship
Phone
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MEDICAL AUTHORIZATION FORM
FFA CLAY TRAP
Student Name:_____________________ Home Phone:______________
Age:________ Address:______________________________________
Street
City
Zip
Parent/Guardian Name:_______________________________________
Last
First
Father’s Employer: ______________________ Phone:______________
Mother’s Employer: ______________________ Phone:______________
Family Physician:________________________ Phone:______________
Name of Person to contact if parent/guardian is unavailable:
_________________________________________________________
Name
Relationship
Phone
List any medication student is currently taking:______________________
_________________________________________________________
List any know medical problems or allergies:________________________
_________________________________________________________
Medical
_____________________ ________________________
Insurance
Company Name
Name of Insured
Information
____________________ ________________________
Policy Number
Group Number
“In case of serious illness or accident, I request the activity sponsor contact me. If I cannot be reached, I herewith authorize contact of
the physician indicated above. If it is not possible to contact the physician, I authorize the teacher/advisor to arrange for all necessary
medical services for said child on my behalf.”
Signature: _________________________ _______________
Parent/Guardian
Date
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Summer Creek Community Church Skeet Shoot
Liability Release Form
Summer Creek Community Church has taken reasonable steps to provide a safe environment for participation in this event;
however these activities are not without risk. The same elements that contribute to the character of this activity can be
cause of loss or damage to your property, accidental injury, or, in extreme cases, permanent trauma or death.
I, the undersigned, understand that no activity is absolutely safe and free of risk. I agree to assume responsibility for
myself and that of my family, including minor children. I expressly assume all risk and responsibility involving accidents
sustained while participating.
I affirm that I am fully capable of participating in this event and that my general health is good, that I do not have any
condition that might endanger the life or health of myself or others participating in this event. I affirm that I know of no
reason why I should not participate.
I affirm that I am sufficiently knowledgeable of basic gun safety and am capable of handling fire arms in a safe manner. I
affirm that I have read, understand and agree with the Basic Fire Arms Safety Rules and ACC Skeet Shoot Rules that have
been given to me.
I acknowledge that this Liability Release Form will be used by Summer Creek Community Church and its representatives
for this event, and that it will govern my actions and responsibilities at said event.
I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or
illness during this event.
I, the undersigned, do hereby verify that the information on this form is correct, and I do hereby release and forever
discharge all sponsors and Summer Creek Community Church from any and all claims, demands, actions or cause of
action, past, present or future, arising out of any injury while participating in the event.
Name: _______________________________________________
Address: ____________________________________________________
Phone: _________________________________ Date of birth: ______/______/_____
E-mail: ____________________________________________
I hereby give permission to Summer Creek Community Church to use pictures or video images from this event for future
events.
For a MINOR CHILD, (under 18 years of age) please fill out the information below and sign:
As a parent or legal guardian of ______________________________________, I _____________________________
further accept responsibility for actions of this child, and agree to the provisions of above.
ACKNOWLEDGEMENT OF RISK, WAIVER, RELEASE AND INDEMNIFICATION.
Dated: ________________________________________
Signed: _______________________________________
In case of emergency, notify: ______________________________ Phone: __________
Family Physician: _________________________________ Phone: ______________
Family Insurance Co.: _________________________________ Policy #____________
4-H Shooting Sports Guide
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