Course Registration Form

Training Assessment Form

Please complete the following form so that we can make training recommendations and guide you towards the most appropriate class for your particular needs. All information will be kept STRICTLY CONFIDENTIAL and will be used only for your educational development. Thank you in advance for your time and interest!
Student Name*

First NameLast Name
Birth Date*

MonthDayYear
Gender*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*
Student E-mail*
example@example.com
Mobile Number*
Phone Number
Work Number
Would you like us to reach out directly?*
Which course(s) are you interested in?*

Basic PistolWomen's Basic PistolWomen's IntermediateWomen's AdvancedMace® Defensive SprayHandgun Cleaning ClassLegal Use of ForceChildren's Firearm SafetyConcealed Carry and Home DefenseSelf Defense (hand to hand)TSA Traveling with a FirearmPrivate LessonsMD Wear and Carry PermitSimulator Training
Additional training interests?*
What would you like to learn? please be specific.
Select one*
Are you a veteran or first responder*
Select all that apply

Active DutyRetiredAir ForceArmyNavyMarinesPoliceFireCoast GuardReservesNational GuardEMT/MedicalForeign MilitaryOther
How did you hear about us?*
List any firearms education and experience*
Which best describes you? (select all that apply)*

I've never seen a real gun up closeI've seen but never shot a gunI've shot a gun a few timesI shoot guns regularlyI grew up around gunsOther
Do you own a gun?*
Select all that you own:*

RevolverSemi-automatic pistolShotgunRifleAll of the aboveNone of the aboveOther
Are you a member of a gun range?*
Do you have a carry permit?*
Please answer the following

On a scale of 1-5, with 1 being the LEAST and 5 being the MOST , answer the following.
How comfortable are you around loaded firearms?*

1

2

3

4

5

1 is Uncomfotable, 5 is Comfortable
How strong do you feel your firearms safety skills are?*

1

2

3

4

5

1 is Weak, 5 is Strong
How accurately do you feel you can shoot a firearm?*

1

2

3

4

5

1 is Not very, 5 is Very
How familiar are you with local firearm laws?*

1

2

3

4

5

1 is Unfamiliar, 5 is Familiar
Which of the following concern you? (select all that apply)*

Firearm accidentsHome invasionsHome burglarySexual AssaultYour safety outside the homeYou families safety outside of the homeYour ability to protect yourself and loved onesAll of the aboveNone of the aboveOther
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Training Assessment Form

Please answer the following