Firearms Training Waiver

Please fill out the following form.

Have you ever been convicted, plead guilty or no contest before a court for any federal, state or municipal criminal offense, such as a misdemeanor/felony, regardless of the age of conviction? Please include any felony/misdemeanor driving offenses such as Driving While Suspended, DWI (Driving Under the Influence) or OWI (Operating a Vehicle Under the Influence). Traffic infractions (ie speeding or parking tickets) are not required for disclosure.

Have you ever received probation or community supervision for any federal, state or municipal criminal offense?

Have you ever been convicted of any criminal offense in a country outside the jurisdiction of the United States?

Do you currently have any pending charges against you?

I affirm that I am aware that Firearms and Self-Defense training and operations have inherent risks which may result in serious injury or death. I acknowledges that the reaction to, possession of, and/or use of firearms is potentially dangerous, and involves risk of serious personal injury, death, psychological trauma, and/or other personal and financial liability.

The undersigned agrees to assume all risk and waives any and all claims of liability for personal injury, death, psychological trauma, and/or other personal or financial loss. I understand that operating firearms with explosive components involves certain inherent risks which may require transport to a medical facility; explosive detonations, misfiring, hang firing, and other malfunctioning of ammunition, the firearm or its components; ricocheting of projectiles, or impacted materials which may occur during training. I understand that the activities, which are necessary for training and for certification, maybe conducted at a site that is remote, either by time or distance or both, from such a medical facility. I still choose to proceed with such instructional activities in spite of the possible absence of a medical facility in proximity to the training site. Adir Rafael, the facility at which I receive my instruction, nor any of their respective employees, officers, volunteers, agents, contractors, or assigns, (hereinafter referred to as ‘‘Released Parties’’) may not be held liable or responsible in any way for any injury, death, or other damages to me or my family, heirs, estate, or assigns that may occur as a result of my participation in this firearms class or as a result of the negligence of any party, including the Released Parties, whether passive or active. 

In consideration of being allowed to participate in this course, I hereby personally assume all risks of this course, whether foreseen or unforeseen, that may befall me while I am a participant in this course, including but not limited to the academics, travel, or practical firing activities. I further release, exempt, and hold harmless said course and Released Parties from any claim or lawsuit by me, my family, estate, heirs, or assigns, arising out of my enrollment and participation in this course including both claims arising during the course or after I receive my certification. I also understand that shooting and participating in live fire exercises are physically strenuous activities and that I will be exerting myself during this firearms training course, and that if I am injured as a result of a heart attack, panic, hyperventilation, or any other cause, that I expressly assume the risk of said injuries and that I will not hold the Released Parties responsible for the same. I further state that I am of lawful age and legally competent to sign this liability release, or that I have acquired the written consent of my parent or guardian. I understand the terms herein are contractual and not a mere recital, and that I have signed this document of my own free act and with the knowledge that I hereby agree to waive my legal rights. I further agree if any provision of this Agreement is found to unenforceable or invalid, that provision shall be severed from this Agreement. The remainder of this Agreement will then be construed as though the unenforceable provision had never been contained herein.

I, BY THIS INSTRUMENT AGREE TO EXEMPT AND RELEASE MY INSTRUCTOR, ADIR RAFAEL, THE FACILITY THROUGH WHICH I RECEIVE MY INSTRUCTION, AND ALL RELATED ENTITIES AS DEFINED ABOVE, FROM ALL LIABILITY OR RESPONSIBILITY WHATSOEVER FOR PERSONAL INJURY, PROPERTY DAMAGE, WRONGFUL DEATH HOWEVER CAUSED, PSYCHOLOGICAL TRAUMA, AND/OR OTHER PERSONAL OR FINANCIAL LOSS INCLUDING, BUT NOT LIMITED TO, THE NEGLIGENCE OF THE RELEASED PARTIES, WHETHER PASSIVE OR ACTIVE. I HAVE FULLY INFORMED MYSELF OF THE CONTENTS OF THIS LIABILITY RELEASE AND ASSUMPTION OF RISK AGREEMENT BY READING IT BEFORE I SIGNED IT ON BEHALF OF MYSELF AND MY HEIRS.

I understand, whether or not in actual use, gun ranges pose risks that can result in many forms of damage or injury caused by the equipment, other users and even environmental risks including but not limited to sound and air and chemical pollutants all of which are part of the normal shooting sports range environment. If you are pregnant, suffer from respiratory problems, visual impairments, are susceptible to loud noises and even metal allergies YOU SHOULD CONSULT YOUR DOCTOR PRIOR TO ENGAGING IN ACTIVITIES INVOLVING EXPOSURE TO LEAD OR LOUD NOISES OR ANY OF THE OTHER ENVIRONMENTAL ISSUES LISTED ABOVE.

I understand that by providing my Electronic Signature and by clicking on the "l agree" button below, and clicking on the "next" button below, that I am electronically signing this Consent.