Home
About
Reviews
Our Courses
Private Coaching Session
Upcoming Courses
Gear
Blog
Contact
✕
"
*
" indicates required fields
1
Applicant Information
2
Medical & Emergency
3
Liability & Media Waivers
4
Create Account
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
Country
Date of Birth
*
Mobile Phone
*
Are you a US citizen?
*
Yes
No
If no, what is your residency status?
*
Gender
*
Male
Female
Have you ever been convicted in any court of a violent crime, domestic violence, misdemeanor, or felony?
*
Yes
No
Are you under indictment or currently involved in any felony?
*
Yes
No
Are you a fugitive from justice?
*
Yes
No
Have you ever been adjudicated mentally deficient or incompetent?
*
Yes
No
Have you ever renounced your US citizenship?
*
Yes
No
Are you a member of any criminal gang or organization hostile to the US constitution?
*
Yes
No
Do you have any outstanding warrants?
*
Yes
No
Have you ever had a firearms identification card or concealed carry permit refused or revoked?
*
Yes
No
Unfortunately, we are unable to register you for a class at this time.
Experience
Do you have any firearms training experience?
*
Yes
No
What is the most recent course you have taken (please include month & year)
*
Please list out the firearms you have had prior training in
*
What valid (unexpired) certifications do you hold relative to firearms, martial arts, combat training, medical, or emergency services training?
Are you currently or previously LEO or Military?
*
Yes
No
Have you ever been discharged, under dishonorable conditions, from the Armed Forces?
*
Yes
No
Unfortunately, we are unable to register you for a class at this time.
Do you currently or have in the past worked in a security field and/or related area?
*
Yes
No
If yes, please list in what capacity
*
Please type your expectations for this firearms training course in the box below.
*
Do you have any health concerns that may affect your ability to do physical activity or require any special accommodations?
*
Yes
No
Please list any allergies, including seasonal (type N/A if none)
*
Do you use any illegal substances?
*
Yes
No
Unfortunately, we are unable to register you for a class at this time.
IN CASE OF EMERGENCY
Emergency Contact Name
*
Relationship
*
Friend
Relative
Third Choice
Emergency Phone
If you are or suspect yourself to be pregnant, it is strongly recommended that you refrain from any physical shooting activity due to possible lead contamination.
RELEASE AND WAIVER
In consideration of Citizens Defense Training LLC, its managers, owners, agents, contractors and associated companies and/or employees (hereinafter collectively referred to as CDT), and in consideration of my participation in events/training at any locations or ranges where events/training is being hosted by CDT (hereinafter referred to as the Range), I AGREE TO THE FOLLOWING:
I fully understand and acknowledge that (a) risks and dangers exist in my use and observation of firearms and ammunition; (b) my participation in such activities and/or use of such equipment may result in my injury or illness including, but not limited to bodily injury, strains, fractures, partial and/or total paralysis, hearing loss, eye injury, blindness, heat stroke, heart attack, lead contamination, and other ailments that could cause serious disability or death; and (c) that I assume all risk, on behalf of myself, my next of kin, and my beneficiaries, even those arising out of either unintentional or willful negligence of any other party, including CDT.
*
I agree
I, on behalf of myself, my personal representatives and my heirs, hereby voluntarily agree to release, waive, discharge, hold harmless, defend and indemnify CDT from any and all claims, actions, losses for bodily injury, property damage, wrongful death, loss of service or otherwise which may arise out of any use of firearms, ammunition or related equipment, or my participation in or observation of shooting or other activities on the Range.
*
I agree
I agree to follow all safety rules posted or given verbally by any of CDT Staff. Specifically, I also agree to wear and provide my own eye and ear protection, at all times, while on the Range (unless CDT agrees to loan eye/ear protection for temporary use).
*
I agree
I also agree not to be under the influence of alcohol or any other intoxicating substance while attending events at the Range.
*
I agree
I agree that CDT, any press or private parties present, have all rights to use my photograph or image, taken while on Range property. This use includes publishing in magazines, advertising, videos, internet websites or other, as long as it is not altered to show other than actual activities in a way that could be harmful to my character. I forfeit any rights to civil action or claims in any use of my image described above. All photographs taken on the Range property remain the property of CDT and may not be used or reproduced without the express written permission of CDT management.
*
I agree
I further understand that CDT is not responsible for my possessions, if they should be lost, stolen, damaged or destroyed, including any vehicle damage that may occur in driving to or parking on or near Range property.
*
I agree
I HAVE READ THE FOREGOING WAIVER AND RELEASE AND I HEREBY AGREE TO ALL OF THE ABOVE CONDITIONS.
*
I agree
Signature of Participant
*
Email
*
Enter Email
Confirm Email
Password
*
Enter Password
Confirm Password
✕
Cart
This site uses cookies to improve your user experience.
Read More
Okay