STUDENT REGISTRATION FORM
$50.00 nonrefundable registration fee will be required to secure your seat. You can pay the remaining balance the day of class. Submit your form and you will be redirected to the payment portal.
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Course you are signing up for
*
Please Select
Defensive HG1
Defensive HG2
Defensive Shotgun
Defensive Rifle1
Defensive Rifle 2
Defensive Tactics (Self-Defense)
Date of the selected course
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What Courses do you have interest in?
*
Defensive HG1
Defensive HG2
Defensive Shotgun
Defensive Rifle 1
Defensive Rifle 2
Defensive Tactics (Self Defense)
Law Enforcement/Security Firearms Courses
Law Enforcement/Security Defensive Tactics Systems
Type of Firearm you will be using Make/Model
Type of Firearm you will be using Make/Model
List your training/experience level or background in this field of training
*
What are you wanting to get out of this course?
*
Do you have any concerns about this course? If so, please explain what they are
*
Is there anything that the instructors need to be aware about, or that could prevent you from completing this course?
*
YES
NO
If yes please explain
*
Date of Submission
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Applicant is under the age of 18 years old?
YES
NO
Parent/Guardian
First Name
Last Name
Parent Guardian Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Signature
Submit
Should be Empty: