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Mac Megantereon
2015-04-04T08:05:24-07:00
Bay Area Firearms Instruction Company Shooter/ Student Waiver 390 Lang Rd, Burlingame, Ca 94010
Name
*
First
Last
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
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Maryland
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Northern Mariana Islands
Ohio
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Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Phone
*
Number of people taking the course
*
Please enter a number from
1
to
100
.
Preferred days and times and any comments
Please choose which course(s) you wish to take
Tactical Pistol - $295
Tactical Rifle - $250
Tactical Shotgun - $259
Introductory Shooter Bundle - $130.00
Quick Lesson - $69
First Steps Shogun - $149.00
First Steps Rifle - $149.00
First Steps Pistol - $149.00
Three Gun Shoot - $379.00
Three Gun Tactical Shoot - $495.00
Shogun Certification - $189.00
Rifle Certification - $210.00
Pistol Certification - $189
Intro Shooters Package - $59.00
CPR / AED Adult - $79
CPR / AED Adult+Infant+Child - $90
Personal Protection - $ 395.00
1on1 Private Lesson (1person) -$90 per lesson/hour
1on1 Private Lesson (2person) - $65 per lesson/hour per person
1on1 Private Lesson (2person) - $65 per lesson/hour per person
CCW Florida w/ NRA Basic Postal Cert - $195
CCW California 2-day course - $300
Driver License #
ID will be required for all courses
Issuing State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Date of Birth
*
MM slash DD slash YYYY
1. Are you prohibited by law from owning or possessing a firearm?
*
Yes
No
2. Are you under the indictment for a crime punishable by imprisonment for a term exceeding one year?
*
Yes
No
3. Have you been convicted of a crime punishable by imprisonment for a term exceeding one year?
*
Yes
No
4. Have you ever been adjudicated mentally defective or have you been committed to a mental institution?
*
Yes
No
5. Have you ever renounced your United States citizenship?
Yes
No
6. Have you been convicted in any court of a crime of misdemeanor domestic violence?
*
Yes
No
7. Are you subject to a court order restraining you from harassing, stalking, or threatening an intimate partner or child of such partner?
*
Yes
No
8. Have you been discharged from the Armed Forces under dishonorable conditions?
*
Yes
No
9. Are you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?
*
Yes
No
Are you a citizen of the United States? If not what country do you have citizenship?
*
Yes
No
By pressing submit I certify that the above answers are true and correct and that I am of good moral character. I understand that a person who answers “yes” To any of questions 1-9 is prohibited from possessing a firearm. Furthermore, I or my agent(s), assigns, executors or administrators, for the consideration of being allowed to enter, rent and use the facilities, firearms and services at Burlingame scuba center, bay area firearms instruction company, Scott Jackson, and for the valuable consideration to hereby absolutely and unequivocally agree to release and save harmless, bay area firearms instruction company, Scott Jackson, Burlingame scuba center, its agents, employees, instructors, my instructors assigns from any claim demand or liability whether claimed by myself or another arising out of injury, loss or disability connected with above facilities and services, including but not limited to damage or injury resulting in clearing of a customers jammed or malfunctioning firearm by either my instructors, Scott Jackson, bay area firearms instruction company, or authorized agents.
If patron is under 18 the form must be filled out by a parent or guardian.
Δ
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