URBAN TACTICAL USA : STUDENT APPLICATION FORM
Course Title: ___________________________________________________________ Course Dates: _________________
Urban Tactical USA requires the full payment in advance to reserve your place in the class. Cancellation one week or more prior to the course start date will receive a full refund. Cancellation less than one week prior to the course start date will incur a $50.00 administrative service charge. No shows will not receive a refund.
Complete the application and mail it with your payment (made payable to Urban Tactical USA) to:
Urban Tactical USA
P.O. Box 641
Sloughhouse, Ca. 95683
Name: ______________________________________________________________________________________________
Address: ____________________________________________________________________________________________
City: ______________________________________________________ State: _______________ Zip: ________________
Home Phone: _______________________________________ Cell Phone: ______________________________________
E-mail: ______________________________________________________________________________________________
Student Agreement
I understand this course will involve using a deadly weapon, and conducting a proper and safe class requires all students to fully cooperate with the instructor(s). I understand that my participation in this course may be terminated at any time, without refund, if the instructor(s) deem my participation unsatisfactory. I agree to abide by all safety procedures required in the course. I agree to sign a waiver releasing Urban Tactical USA from any and all responsibility for any injury or damages I may sustain during the training program.
I certify that I am not a fugitive from justice, or under indictment. I have not been convicted of a felony or misdemeanor. I am not drug or alcohol dependent. I am not under adjudication of mental incompetence. I have not been convicted for domestic violence. I am not prohibited by any Federal, State, or local law or ordinance or court order from owning, possessing, or using firearms. I am at least 21 years of age or older.
Print Name:___________________________________ Sign:_________________________________ Date:____________ |
