If you are NOT a United States citizen, I cannot teach you. Please do not continue this application.
Declaration of United States Citizenship or Permanent Residency
Under the International Traffic in Arms Code of Federal Regulations (ITAR CFR) section 120.3, it is unlawful for any United States citizen to provide firearms instruction of any kind to any non-United States Citizen. Permanent residents holding a valid permanent resident green card are exempt from this restriction.
In an effort to conform to all local, state and federal laws, Forward Safety Training, LLC requires a Declaration of United States Citizenship or Permanent Residency from all students participating in any firearms related training including but not limited to basic marksmanship instruction, firearms cleaning and maintenance, defensive shooting skills, firearms safety instruction or any advice, information, or technical data pertaining to the use of firearms.
ITAR 22CFR 120.13:
1. The furnishing of assistance (including training) to foreign persons, whether in the United States or abroad in the design, development, engineering, manufacture, production, assembly, testing, repair, maintenance, modification, operation, demilitarization, destruction, processing or use of defense articles;
2. The furnishing to foreign person of any technical data controlled on the USML whether in the United States or abroad; or
3. Military training of foreign units or forces, regular and irregular, including formal or informal instruction of foreign persons in the United States or abroad or by correspondence courses, technical, education, or information publications and media of all kinds, training aid, orientation, training exercise, and military advice.
Foreign Persons is defined as any non-U.S. citizen residing in the U.S. whether or not said person has a legal immigration status. Persons holding Permanent Resident status shall not be defined as Foreign Persons and therefore not held applicable to 22CRF.120.
By signing below, you hereby declare that you are a United States Citizen or Green Card holding Permanent Resident and therefore are eligible to receive lawful firearms instruction from Forward Safety Training, LLC.
For those under age that need a guardian:
Name of student: ____________________________
Guardian Signature: __________________________________________
Guardian Driver’s License #: __________________________________________
I hereby certify that I have witnessed the above Declaration of United States Citizenship or Permanent Residency and believe to the best of my knowledge that the above named person has read and answered this document completely and truthfully.
First Name Last Name Driver's License Numberblanks Today's Date: blank Birth Date:
RELEASE AND HOLD HARMLESS AGREEMENT
I recognize and understand that there are risks associated with the use of firearms and being in proximity of their use. I voluntarily assume all risk of injury and loss from all such activities of Rebecca Mosbrucker.
Therefore, in consideration of allowing me to participate in a safety or pistol class, for and on behalf of myself and my family, heirs, executors, administrators, successors, and assigns, I irrevocably and unconditionally release and hold harmless Rebecca Mosbrucker and her affiliates, managers, members, representatives, agents, servants, officers, insurers, employees, successors, and assigns, from any and all liability for all claims, damages, losses, and injuries that I might suffer or incur from all causes whatsoever as a result of participation in all events held, sponsored, or endorsed by Rebecca Mosbrucker, including but not limited to all losses caused wholly or in part by the negligence of Rebecca Mosbrucker or any other person or entity for whose acts or omissions could be held responsible or liable in any manner.Further, for and on behalf of myself and my family, heirs, executors, administrators, successors, and assigns, I covenant and agree not to sue Rebecca Mosbrucker and her affiliates, managers, members, representatives, agents, servants, officers, insurers, employees, successors, and assigns for any injury and loss that arises from or results from my conduct or the conduct of another or arises from or results while participating in or attending any event held, sponsored, or endorsed by Rebecca Mosbrucker.******************************************************Permission to Use Photograph
I grant to Rebecca Mosbrucker, her representatives and employees, the right to take photographs of me and my property in connection with the above-identified subject. I authorize Rebecca Mosbrucker, her assigns and transferees to copyright, use and publish the same in print and/or electronically.I agree that Rebecca Mosbrucker may use such photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
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