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BLACK OPS SCHOOL OF COMBAT

2007 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 FROM 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 forfeit 25.00 of my deposit the rest of which will be returned to me. If we at Black Ops cancel the course for any reason the full deposit will be returned to you. No deposits may roll over into another course!

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: ________________

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

NOTICE: All deposits and applications must be in two weeks prior to the course taken or a 25.00 late fee will be added to the cost of the course.