In submitting this form I acknowledge and represent that:

• I am a citizen of the United States.

• I have never been convicted, under indictment, or a fugitive from justice of a felony or crime of violence.

• To the best of my belief and knowledge, I am not prohibited by law from possessing or using firearms.

• I certify that I will use this training in a safe and lawful manner. Any failure on my part to maintain a safe atmosphere will constitute grounds for immediate dismissal from the class.

• I understand and acknowledge that neither Justin Goggans, Amanda Bunch, nor assisting instructors (hereinafter referred to as “instructors”) are attorneys or members of the judiciary. All information provided by them concerning self-defense and the use of force is provided from the standpoint of laymen and not from the standpoint of members of the legal profession. I have been advised of the need to contact an attorney of my choice for legal advice on any specific legal problems or questions I might have regarding: ACA §5-73-301, all applicable rules, laws, and codes pertaining to training topics.

• I am fully aware of risks and hazards connected with being on the premises and participating in the firearm training, and I am fully aware that there may be risks and hazards unknown to me connected with being on the premises and participating in firearm training, and I hereby elect to voluntarily participate in the firearm training, and engage in activities knowing that conditions may be hazardous, or may become hazardous or dangerous to me and my property.

• I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of my being a participant in the firearm training, whether caused by the negligence or otherwise.

• I hereby release, waive, discharge and covenant not to sue the instructors and range landowners (Osage Range) for any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury, including death, that may be sustained by me, or to any property belonging to me, whether caused by the negligence, or otherwise, while handling & shooting firearms or upon the premises.

• It is my express intent that this release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a release, waiver, discharge and covenant not to sue the instructors.

• I consent to receiving SMS messages on this class and future training opportunites.