Please print and complete this page, and mail with a check or money order to:
17205 Gaddy Road
Shawnee, Oklahoma 74801
1. Please reserve a slot for me for class number SI____, on preferred date:
|(1st choice)||(2nd choice)||(3rd choice)|
2. Enclosed is my deposit of ¼ the course fee to reserve my slot. (Note: If for some reason you are not accepted, your deposit will be refunded to you. If you cancel after notice of confirmation your deposit is not refundable. The remaining Tuition fees are to be paid upon arrival at the academy and are not refundable.)
3. Are you under indictment or have you ever been convicted of a felony? Yes / No (circle one)
4. Are you now or have you ever been under treatment for any mental disorder? Yes / No (circle one)
5. By signing below I certify that I am 18 years of age or will be accompanied by a parent or guardian.
6. I agree to abide by all safety and range rules required by Shoot-N-Iron Academy. I understand that by voluntarily participating in the class or classes for which I have registered that I release Shoot-N-Iron, Inc. and all instructors from liability for any injury I may sustain and for any acts or omissions.
7. READ: Our training programs and safety operations depend upon careful control of weapons and the complete cooperation of our students. It must be understood that a student's instruction may be terminated any time his or her cooperation is deemed to be unsatisfactory by the academy staff.
|(Date)||(Student signature)||(If married, spouse's signature)|
|(Print full name)||(Date of Birth)||(Occupation)|
|(Mailing address)||(City)||(State)||(Zip Code)|
|(____) ____-________||(____) ____-________|
|(Home Phone Number)||(Business Phone Number)|
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