This form is not required for Handgun Permit Class. Just show up the day of the class.
Course Application
Form AR15 & Handgun For Personal Protection Class.
Please print and
completely fill out. Blanks will void application.
Name:
_____________________________________________________________
(Last, first, middle)
Address:
___________________________________________________________
City:
_______________________________State:_________Zip:_______________
Phone
____________________________ (other) ______________________
Email
______________________________________________________________
Date of Birth:
___________________Place of Birth__________________________
Place of Employment:
_________________________________________________
Prior Firearms
Training________________________________________________
Type of firearm to be
used in class_______________________________________
Type of optics to be used with firearm:
____________________________________
Please
write “yes” or “no” in blank to left of question:
1.Do you have any
criminal convictions of any crimes to include: Any felony crime, crimes of moral
turpitude, or domestic abuse? (If yes, please explain on additional sheet and
attach to the back of this applications form)_________
2.Are you an illegal
alien in the United States of America? __________
3.Can you legally own the firearm you
will be training with? __________
4.Do you have any
illnesses or disabilities that may prevent you from participating in physical
events or withstanding high temperatures for extended periods of time?
_______________
5.Are you or have you
been a member of any clandestine groups to include militias or hate groups? (If
yes, please explain on additional sheet and attach to the back of this
applications form, including status with such groups.) ___________
6.
Continued.....Have you ever been found mentally incompetent or have any mental
illness that my compromise your judgment?______________
Please
check all that apply, but at least one of the following:
___ I am currently a
certified law enforcement officer
___ I am currently
serving in the active or reserve Armed Forces or National Guard.
___ I am a civilian
enthusiast
___ Other interests
(please explain) _________________________________
Describe
your interests in this course:
What
are your expectations of this course?
What
other course(s) would you like to see offered in the future?
Emergency
contact: (person to be contacted in case of accident or emergency)
Name
_____________________ Address __________________________________________
Telephone number(s) Home ( )
_____-________ Work ( )
_____-________ Relationship ______________
By signing below, I
agree and testify to the best of my knowledge the above information is true and
correct. I also agree that at the discretion of Mike Kidd, I may be
removed from the course for violating any safety rule of firearms handling, or
display of moral incompetence. Furthermore, this application DOES NOT grant
immediate approval/acceptance into the course, and that I will be informed at a
later date of my acceptance/rejection into the course.
Signed: _________________________ Date: _____________
Please enclose a 50% deposit with enrollment form. Course cost is $150. Deposit of $75 is requested. Checks are payable to:
Mike Kidd
383 Rockingham Rd
Gray, Tn 37615