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BLACK OPS SCHOOL OF COMBAT

2010 TRAINING APPLICATION

PLEASE COMPLETE A SEPARATE FORM FOR EVERY MEMBER OF YOUR FAMILY THAT IS TAKING THIS COURSE. ALSO IF YOU ARE APPLYING FOR MORE THAN ONE COURSE USE A SEPARATE FORM FOR EACH COURSE.

COURSE REQUESTED: ______________________________ DATE OF COURSE: _____________

COST OF THE COURSE: _______________ AMOUNT OF DEPOSIT: _____________

POLICY FOR DEPOSITS AND REFUNDS: READ CAREFULLY!

I enclosed my deposit of 50.00 for the cost of the above course. I understand that the balance is due on the day of the course. I also understand that if I cancel for any reason I will not receive any refund on my deposit. You may roll your deposit over into another course later in the year, but you must take that course before the end of the same year. After the end of the year you lose both the deposit and the opportunity to roll it over into another course. If we at Black Ops cancel the course for any reason the full deposit will be returned to you.

BASIC REQUIREMENTS:

1. I am a citizen of the United States of America and have never nor do I intend to renounce my

Citizenship. (Proof of citizenship is required).

2. I agree to abide by the safety rules and procedures while on the range as required by Black Ops

Instructors. I realize that ANY violations of safety procedures or ANY acts deemed unsafe

by any of Black Ops instructors will result in my IMMEDIATE termination from the course

and shooting range and that I will forfeit all monies paid.

3. I also will agree to sign a hold harmless agree that releases McLaughlin & Sons D/B/A as Black

Ops School of Combat or any other of their instructors, from any injury I may sustain while

training.

4. I have never been convicted as a felon, nor is it unlawful for me to own, possess or train with a

firearm.

STUDENT’S SIGNATURE: ______________________________________ DATE: _______________

(Please print all information clearly and your name exactly as you want it to appear on your certificate)

NAME: _____________________________________________________

ADDRESS: __________________________________________________

CITY: _____________________________________ STATE: _________ ZIP: ___________________

PHONE: ___________________________________ REFERRED BY: __________________________

E-Mail Address: _____________________________________________________

TYPE OF FIREARMS YOU WILL BRING TO THE COURSE: (MAKE, MODEL & CAL.)

PISTOL __________________ SHOTGUN: __________________ RIFLE: __________________

If possible we recommend that you bring two pistols to any pistol course in the event one breaks or becomes inoperable during the shoot.

Have you had any firearms training prior to this course? ________________

If so, on the back of this form give a brief description of what type of training and where you received it.

BLACK OPS SCHOOL OF COMBAT 1395 Co. Rd. 6310 West Plains, Mo. 65775

PHONE: 417-255-1612 FAX: 417-256-3947