10th VIRGINIA VOLUNTEER INFANTRY REGIMENT
Companies A-L, Inc.
Membership Application
Applicant's Name: ________________________________________________________
Social Security Account Number: _____________________________________________
Address (City, State, Zip): ________________________________________________
_________________________________________________________________
Phone: ________________ Birthdate: ________________________________ Age: _____
Recommended by: ________________________________________________________
If you currently belong to any reenactment or living history groups, please
list and give address(es): _________________________________________________
_______________________________________________________________________
_______________________________________________________________________
List previous reenactment or living history groups, other than above
(give address/es if possible):
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
How long have you been involved in reenacting/living history? _____________________
Do you currently own a uniform, weapon, or accoutrements? If so, list:
_______________________________________________________________________
_______________________________________________________________________
List previous experience with firearms:
_______________________________________________________________________
Briefly, why do you wish to join?:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Do you have any physical disabilities? If yes, describe and list
medications if any: ___________________________________________________
_____________________________________________ Doctor's phone: _____________
Have you ever been arrested for other than minor traffic violations?
___________________________________________________________________
List talents that may be of use to the Regiment:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
I understand if I am accepted for membership, I will be part of a unit
and will be expected to attend as many unit functions regardless of type
as possible. I further understand my repeated failure to attend unit functions
without reason could result in my dismissal.
Signature ____________________________________________ Date ________________
See the following and complete as necessary. The first certification applies to members who apply on their own behalfs. The second certification is for minor recruits (younger than age 18), and is to be completed by the responsible parent or legal guardian.
For Adult Applicants
I certify by my signature below I have read and fully understand the following statements.
- Battle reenactments, musket demonstrations, camps, living history demonstrations, etc. have inherent dangers involved, and I understand I am ultimately responsible for my safety. In exchange for being allowed to participate with the 10th Virginia Volunteer Infantry Regiment, Companies A-L, Inc., I release from liability, and promise not to sue, any member of
the aforementioned unit.
- If, despite this agreement, I do sue a member of the aforementioned unit, I agree to pay all costs and expenses (including actual attorney fees) incurred by the sued member in defending the suit.
- I do not release from liability, nor do I promise not to sue, a person who harms me or my property intending that harm, or with actual knowledge that the specific harm was certain to result.
- If a person other than myself (for example, my spouse, children, relatives, or any other person) assets a claim against a member of the aforementioned unit arising out of harm to me or my property, I promise to pay whatever amounts (including damages, costs, and actual attorney fees) the sued member incurs because of the claim.
I have read, understand, and agree to be bound by all of this document. Nevertheless, if any part of it is found unenforceable, I agree to be bound by the remaining parts.
Date: _______________
__________________________________
Signature of adult applicant.
For Minor Recruits
(under age 18)
To be completed by the responsible parent or legal guardian.
I certify by my signature below I have read and fully understand the following statements.
- Battle reenactments, musket demonstrations, camps, living history demonstrations, etc. have inherent dangers involved, and I understand my son is ultimately responsible for his safety. In exchange for being allowed to participate with the 10th Virginia Volunteer Infantry Regiment, Companies A-L, Inc., I release from liability, and promise not to sue, any member of
the aforementioned unit.
- If, despite this agreement, I do sue a member of the aforementioned unit, I agree to pay all costs and expenses (including actual attorney fees) incurred by the sued member in defending the suit.
- I do not release from liability, nor do I promise not to sue, a person who harms my son or his property intending that harm, or with actual knowledge that the specific harm was certain to result.
- If a person other than myself (for example, my spouse, children, relatives, or any other person) assets a claim against a member of the aforementioned unit arising out of harm to my son or his property, I promise to pay whatever amounts (including damages, costs, and actual attorney fees) the sued member incurs because of the claim.
- I hereby relieve the commander and all members of the 10th Virginia Volunteer Infantry Regiment, Companies A-L, Inc., as a group, of the responsibility to 'baby-sit' my son. I understand he is attending and participating in these activities as a member of a group and will be treated as his historical counterpart.
- I hereby freely give my permission for my son to participate in events attended by members of the aforementioned unit.
- I hereby give my permission for emergency treatment to be given to my son in the event it is necessary for his life, health, or well-being.
I have read, understand, and agree to be bound by all of this document. Nevertheless, if any part of it is found unenforceable, I agree to be bound by the remaining parts.
Date: _______________
__________________________________
Signature of adult member or parent or legal guardian of minor recruit.
You may print this page, fill it out, and mail it to the unit commander, Jeremy Hilliard, at the following address:
Jeremy Hilliard
729 Circle View Road
Luray, VA 22835
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