Intake

Intake, release, waiver

Name(Required)
Address(Required)
MM slash DD slash YYYY
Areas Of Interest Check All That Apply(Required)
Emergency Contact Name(Required)
How Did You Hear About Us?(Required)

RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS AND ASSUMPTION OF RISK AGREEMENT WHEREAS, in consideration of being permitted to attend a course for the instruction in firearms, for the instruction in firearms, for use of premises, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Undersigned agrees to the following: Undersigned agrees to indemnify, hold harmless and defend Richard S. Mitchell Jr., Melody Mitchell, Atlantic Tactical Firearms Trainers and Mitchell's Martial Arts (hereinafter referred to as "Instructors"), from any and all fault, liabilities, costs, expenses, claims, demands, or lawsuits arising out of, related to or connected with : Undersigned; Undersigned's presence on or use of the range, building , land, and the premises ("Premises") and, any and all acts or missions of Undersigned. Undersigned furthermore waives for himself/herself and for his/her executors, personal representatives, administrators, assignees, heirs and any next of kin; any and all rights and claims for damages, losses, demands and any other actions or claims whatsoever, which he/she may have or which may arise against Instructor ( including but not limited to the death of Undersigned and/or any and all injuries damages or illnesses suffered by Undersigned or Undersigned's property", which may, in any way whatsoever, arise out of , be related to or be connected with: the course instruction; the Premises; Undersigned's property(whether or not entrusted to Instructor); and the discharge of firearms. Instructor shall not be liable for, and Undersigned, on behalf of himself/herself and on behalf of his/her executors, personal representative, administrators, assignees, heir, and next of kin, hereby expressly release the Instructor from any and all such claims and liabilities. Undersigned hereby expressly assumes the risk of taking part in the course for instruction in firearms and taking part in the activities on the Premises, which include, but are not limited to, instruction in the use of firearms, the discharge of firearms and the firing of live ammunition. Undersigned hereby acknowledges and agrees that Undersigned has read this instrument and understand its terms is executing this instrument voluntarily. Undersigned furthermore hereby acknowledges and agrees that he/she has read, understood and will at all times abide by all range rules and procedures and any other rules and procedures stated by the Instructor. **** Undersigned hereby affirms that they are not considered a restricted person by the state and federal authorities and is not prohibited from the use of firearms. **** Undersigned expressly agrees that this instrument is intended to be as broad and inclusive as permitted by law, and that if any provision of this instrument is held invalid or otherwise unenforceable, the enforceability of the remaining provision shall not be impaired thereby. No remedy, and each and every remedy shall be cumulative and shall be in addition to every other remedy not or hereafter existing at law or in equity or by statute or otherwise. The election of anyone or more remedy hereunder by the Instructor shall not constitute any waiver of instructor's fight to pursue other available remedies. This instrument binds Undersigned and his/her executors, personal representative, administrator, assignees, heir and next of kin. The Undersigned gives consent to be photographed, video taped by staff or media for use in the school, brochures, website and media press. The undersigned understands that in all of our classes the curriculum covers all of the necessary laws required for each course. Unfortunately, most gun and self defense laws are vague and are subject to frequent change. Laws are even more vague when dealing with an unarmed person. It is up to the individual to do their own research and become knowledgeable in the laws that apply to their individual states and situations. Any action you perform in what you believe is in self defense is taken at your own risk.(Required)
MM slash DD slash YYYY
Max. file size: 6 GB.

Intake, release, waiver

Name(Required)
Address(Required)
MM slash DD slash YYYY
Areas Of Interest Check All That Apply(Required)
Emergency Contact Name(Required)
How Did You Hear About Us?(Required)

RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS AND ASSUMPTION OF RISK AGREEMENT WHEREAS, in consideration of being permitted to attend a course for the instruction in firearms, for the instruction in firearms, for use of premises, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Undersigned agrees to the following: Undersigned agrees to indemnify, hold harmless and defend Richard S. Mitchell Jr., Melody Mitchell, Atlantic Tactical Firearms Trainers and Mitchell's Martial Arts (hereinafter referred to as "Instructors"), from any and all fault, liabilities, costs, expenses, claims, demands, or lawsuits arising out of, related to or connected with : Undersigned; Undersigned's presence on or use of the range, building , land, and the premises ("Premises") and, any and all acts or missions of Undersigned. Undersigned furthermore waives for himself/herself and for his/her executors, personal representatives, administrators, assignees, heirs and any next of kin; any and all rights and claims for damages, losses, demands and any other actions or claims whatsoever, which he/she may have or which may arise against Instructor ( including but not limited to the death of Undersigned and/or any and all injuries damages or illnesses suffered by Undersigned or Undersigned's property", which may, in any way whatsoever, arise out of , be related to or be connected with: the course instruction; the Premises; Undersigned's property(whether or not entrusted to Instructor); and the discharge of firearms. Instructor shall not be liable for, and Undersigned, on behalf of himself/herself and on behalf of his/her executors, personal representative, administrators, assignees, heir, and next of kin, hereby expressly release the Instructor from any and all such claims and liabilities. Undersigned hereby expressly assumes the risk of taking part in the course for instruction in firearms and taking part in the activities on the Premises, which include, but are not limited to, instruction in the use of firearms, the discharge of firearms and the firing of live ammunition. Undersigned hereby acknowledges and agrees that Undersigned has read this instrument and understand its terms is executing this instrument voluntarily. Undersigned furthermore hereby acknowledges and agrees that he/she has read, understood and will at all times abide by all range rules and procedures and any other rules and procedures stated by the Instructor. **** Undersigned hereby affirms that they are not considered a restricted person by the state and federal authorities and is not prohibited from the use of firearms. **** Undersigned expressly agrees that this instrument is intended to be as broad and inclusive as permitted by law, and that if any provision of this instrument is held invalid or otherwise unenforceable, the enforceability of the remaining provision shall not be impaired thereby. No remedy, and each and every remedy shall be cumulative and shall be in addition to every other remedy not or hereafter existing at law or in equity or by statute or otherwise. The election of anyone or more remedy hereunder by the Instructor shall not constitute any waiver of instructor's fight to pursue other available remedies. This instrument binds Undersigned and his/her executors, personal representative, administrator, assignees, heir and next of kin. The Undersigned gives consent to be photographed, video taped by staff or media for use in the school, brochures, website and media press. The undersigned understands that in all of our classes the curriculum covers all of the necessary laws required for each course. Unfortunately, most gun and self defense laws are vague and are subject to frequent change. Laws are even more vague when dealing with an unarmed person. It is up to the individual to do their own research and become knowledgeable in the laws that apply to their individual states and situations. Any action you perform in what you believe is in self defense is taken at your own risk.(Required)
MM slash DD slash YYYY
Max. file size: 6 GB.

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