Name

Email Address

Address

City

State

Zip

Phone

Date of Birth

Do You Need a Firearm? Do You Need a Firearm? Yes, I will need a firearm for the Range No, I will bring my own firearm for the Range

Agreement & Waiver of Liability (Required for Class) Agreement & Waiver of Liability (Required for Class) I agree that I assume all risk both in class and at the Range I agree that I will NOT have a loaded firearm in the classroom I agree to wear the proper safety items both at home and on the range I will provide my own ammunition OR Obtain from CCWCleveland

Is there anything we should know prior to your attending class?

Are you hearing impaired or do you have any hearing issues? Are you hearing impaired or do you have any hearing issues? Yes No