STUDENT REGISTRATION FORM

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 NameLast Name
Date of Birth*

MonthDayYear
Date
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Course you are signing up for*
Date of the selected course*

MonthDayYear
Date
What Courses do you have interest in?*

Defensive HG1Defensive HG2Defensive ShotgunDefensive Rifle 1Defensive Rifle 2Defensive Tactics (Self Defense)Law Enforcement/Security Firearms CoursesLaw 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?*

YESNO
If yes please explain*
Date of Submission *

MonthDayYear
Date
Applicant is under the age of 18 years old?

YESNO
Parent/Guardian

First NameLast Name
Parent Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Signature
Should be Empty:

$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.