ACAM SOCIETY E-Waiver
Please fill out the following waiver form before attending your course.
Full Name
*
First Name
Middle Name
Last Name
Suffix
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Have you ever used a firing range before?
*
Yes
No
Do you have any medical conditions that may affect your ability to use the firing range and hands on training safely? If so, explain in detail. Our instructor will contact you if they feel it is unsafe to proceed with your training. (If none, type NONE)
*
Please read and agree to the following safety rules:
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Always keep the firearm pointed in a safe direction.
Keep your finger off the trigger until you are ready to shoot.
Know your target and what is beyond it.
Wear appropriate eye and ear protection at all times.
Follow all instructions provided by your CCW Certified Instructor and range staff.
Do not handle any firearms while under the influence of alcohol or drugs.
Report any unsafe behavior or conditions to your CCW Certified Instructor and range staff immediately.
I have read and understand the safety rules.
By signing this waiver, I acknowledge and agree to the following:
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I understand that shooting can be a potentially dangerous activity and assume all risks associated with using the firing range.
I agree to follow all safety rules and instructions provided by my CCW Certified Instructor and or range staff.
I release the firing range and ACAM SOCIETY LLC and its staff from any liability for any injury, damage, or loss that may occur while using the facility or classroom.
I confirm that I am at least 18 years old and legally allowed to possess and use firearms.
I understand that violating the safety rules may result in immediate expulsion from the firing range and or classroom.
Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: