Register Bay Area Firearms Instruction Company Shooter/ Student Waiver 390 Lang Rd, Burlingame, Ca 94010 Name*FirstLastAddress*Street AddressCityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificStateZIP CodeEmail*Phone*Number of people taking the course*Please enter a value between 1 and 100.Preferred days and times and any commentsPlease choose which course(s) you wish to take*Tactical Pistol - $295Tactical Rifle - $250Tactical Shotgun - $259Introductory Shooter Bundle - $130.00Quick Lesson - $69First Steps Shogun - $149.00First Steps Rifle - $149.00First Steps Pistol - $149.00Three Gun Shoot - $379.00Three Gun Tactical Shoot - $495.00Shogun Certification - $189.00Rifle Certification - $210.00Pistol Certification - $189Intro Shooters Package - $59.00CPR / AED Adult - $79CPR / AED Adult+Infant+Child - $90Personal Protection - $ 395.001on1 Private Lesson (1person) -$90 per lesson/hour1on1 Private Lesson (2person) - $65 per lesson/hour per person1on1 Private Lesson (2person) - $65 per lesson/hour per personCCW Florida w/ NRA Basic Postal Cert - $195CCW California 2-day course - $300Driver License #*Issuing State*AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificDate of Birth* Are you prohibited by law from owning or possessing a firearm?*YesNoAre you under the indictment for a crime punishable by imprisonment for a term exceeding one year?*YesNoHave you been convicted of a crime punishable by imprisonment for a term exceeding one year?*YesNoHave you ever been adjudicated mentally defective or have you been committed to a mental institution?*YesNoHave you ever renounced your United States citizenship?YesNoHave you been convicted in any court of a crime of misdemeanor domestic violence?*YesNoAre you subject to a court order restraining you from harassing, stalking, or threatening an intimate partner or child of such partner?*YesNoAre you a citizen of the United States? If not what country do you have citizenship?*YesNoHave you been discharged from the Armed Forces under dishonorable conditions?*YesNoAre you an unlawful user of, or addicted to, marijuana or any depressant, stimulant, narcotic drug, or any other controlled substance?*YesNoBy 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 the above 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.EmailThis field is for validation purposes and should be left unchanged.