Name *

First Name

Last Name

Phone *

(###)

###

####

Are you legally able to handle a firearm? *

Yes

No

Do you have the physical, mental, and emotional maturity and stability needed to responsibly and safely train with a firearm? *

Yes

No

You Understand and Accept that YOU are responsible for your own range/bay/entry charges/fees unless otherwise stated by the EGPGC. *

Yes, I understand.

No

IF it is not possible to train with the EGPGC at this time, would you be willing to accept information to other gun club and/ or defense organization resources?

Yes, I would like that information if it is available.

No.

Release and Waiver: By checking the "I Agree" checkbox, you hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE the Elmer Geronimo Pratt Gun Club (EGPGC) and its member institutions, or any subdivision thereof, and each of them, their officers and employees, (collectively, the “Releasees”), from and for any liability resulting from any personal injury, accident or illness (including death), and/or property loss, however caused, arising from, or in any way related to, Participant’s participation in Training. *

Yes, I Agree

No, I Do Not Agree and I Accept that I will not able to train with EGPGC at this time..