Kamagong Gun Club Inc.

SUMMARY OF INFORMATION

Instructions:

Answer all questions completely. If the question is not applicable, indicate NA. Use the
back pages of this form for additional details on any and all questions where the blanks
provided are insufficient.

Warning:

The information submitted hereunder shall be considered confidential but will be

subject to verification by the club and the Armed Forces of the Philippines Central Command
(AFP, Centcom).

PERSONAL DETAILS CONTACT INFORMATION

Name: _________________________________________ Residence Tel#: ___________

Home Address: _________________________________ Office Tel#: _______________
________________________________________________
Date & Place of Birth: __________________________
________________________________________________ Email Add: ________________

PERSONAL CHARACTERISTICS

Sex: ____________ Age: ______________ Height: _____________ Weight: _____________

Build: ________________________________ Complexion: ________________________________
Other Distinguishing Features: _______________________________________________________
______________________________________________________________________________________
Significant Medical Problems, if any: __________________________________________________
______________________________________________________________________________________
______________________________________________________________________________________

FAMILY HISTORY AND INFORMATION

Father’s Name: ___________________________ Mother’s Name: ________________________

Date & Place of Birth: _____________________ ________________________
Current Address: ____________________________________________________________________
(please indicate if mother & father are living separately & state the address of both)

MARITAL INFORMATION

Name of Spouse: _____________________________

Children:
Name: ____________________________________ Age: __________________
Name: ____________________________________ Age: __________________
Name: ____________________________________ Age: __________________
Name: ____________________________________ Age: __________________
Name: ____________________________________ Age: __________________
(please use back portion of this page if necessary)
ARREST RECORD AND CONDUCT

Have you ever been arrested and / or investigated for violation of any criminal or civil law? If
so, name the charge and identify the arresting and / or investigating agency or office.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Have you ever been convicted for any criminal or civil offense? If so, identify the violation and
state the penalty as well as the Regional/Municipal Trial Court that conducted the
proceedings.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Has any member of your family, up to the third degree of consanguinity or affinity, ever been
investigated/arrested/convicted of any criminal or civil offense? If so, please identify the
person concerned, the violation/infraction committed, the penalty imposed if any, and the
agency or court that conducted the proceedings.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

Please list down at least three organization that you are a member of and a contact person
whom the Club can refer to for further information that the Club may deem pertinent.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

To help us determine what directions the gun club should take in the years to come, please
explain in detail what you expect to get from your membership to the Kamagong Gun Club
Inc.
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________

CERTIFICATION

I HEREBY certify that the contents of the foregoing document, submitted this
____thday of the month of __________________, in the year of our Lord, 20___, are true
and correct to the best of my knowledge and belief and I agree that any missed
statement or omission will be deemed as grounds for the denial of my application to
membership.

_______________________________
(signature over printed name)
 WAIVER

I hereby waive and renounce any responsibilities and all claims and hold the Kamagong Gun
Club, Inc. / Viscom Firing Range, its officers and members hereto free from any liability either civil,
criminal or otherwise, for any injury or damage that I may suffer, including death, as a result of or in
connection with the handling of firearms within any part of the Philippines and my voluntary participation
in this club. This document will serve as a quitclaim and this waiver shall be valid and binding on my
heirs and successors-in-interest.

I understand and agree that the Kamagong Gun Club, Inc. reserves the right to reject any
application or to exclude, suspend, or dismiss any member for disorderly conduct or behavior or for any
reason, which the officers may deem proper under the circumstances.

I further agree to be guided by the Spirit of Camaraderie and Sportsmanship throughout the
duration of being a member of the Kamagong Gun Club, Inc. and to abide by all safety regulations and
other requirements and procedures governing the conduct of this Club. I understand that my failure to
comply with the said regulation, requirements and procedures will result in my suspension and /or
dismissal from the Club without refund.

I further certify that I have never been convicted or nor am I under indictment for any crime
involving moral turpitude, violence or illegal possession or stolen firearms.

In witness whereof, I have hereunto set my hands this ____ day or ____ 20____ at
__________________________.

______________________________
Print Name and Signature of Applicant

Parental or Marital Consent

______________________
Print Name and Signature
Endorsed for Approval:

_____________________________
Membership Committee Chairman

Approved:

_____________________________
President
Kamagong Gun Club, Inc.