Camp Creek Hunt Club 

Application for Membership

Camp Creek Hunt Club

158 Pine Valley Drive, Stanley, NC 28164

Greg Carroll, Treasurer (704)-681-0086

​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__________________________________