Student Information - Good Guy Academy

Legal Name

First

Last

Name as shown on your driver’s license

Name for Name Badge

What would you like on your name badge?

Full address as shown on Missouri driver's license

Enter your full address including city and zip code

Cell Phone Number

Date of Birth

mm/dd/yyyy

– #2 your

Gender

Brand, Model and Caliber of Weapon you Own for Shooting

Your primary weapon. If none, enter ‘none’.

Mobility Limitations

Describe any mobility limitations that may factor into this course

Rate your Firearms Experience Level (be honest!)

Emergency Contact #1

Name, cell number and relationship

Emergency Contact #2

Name, cell number and relationship

Class Code

Class code from student information package

Certifications – Under Penalty of Law

By checking this box, I certify that I am not a convicted felon and that I have no court order, mental history nor any other history or background that would in any way limit, restrict or prohibit my ability to handle; possess; be associated with; or in the vicinity of, a firearm or any other weapon.
By checking this box, I certify that I am a US Citizen and I am at least 19 years of age as of the first day of the class.
By checking this box, I acknowledge and agree that I must present a valid Missouri driver’s license for inspection by the instructor prior to the start of the class. I further acknowledge that my class registration and attendance is not transferable to another party and that my Missouri driver’s license must match the information provided in this registration form. I further agree to allow the instructor to copy any or all parts of my Missouri driver’s license to be retained by the instructor in the class records.
By checking this box, I agree and promise not to bring a weapon of any type into any building, any classroom, any training room and any ranges associated with this class unless specifically authorized to do so in writing by the instructor. I understand that if I violate this condition, whether intentionally or unintentionally, that I may be removed from the class without a refund; refused a certificate of completion; subjected to liability claims; and criminally charged.
By checking this box, I agree to be on time to all class related activities and in attendance for the entire class. I further agree that improper, forgotten or missing personal identification; tardiness; disruptive behavior or actions; unsafe actions or inactions; failure to follow instructions; violating a safety rule; forgotten, missing or improper safety equipment; forgotten or unsafe firearms; forgotten, unsafe, mismatched or unreliable ammunition; cheating; dishonest conduct; or a lack of active participation constitute grounds for me to be removed from the class without a refund and to be refused a certificate of completion.
By checking this box, I acknowledge and agree that my failure to pass any required written test, oral test; practical test; skills test; or firing range test does not constitute grounds for me to receive a refund; compensation; or consideration in any form or measure.
By checking this box, I acknowledge and agree that photography, videography and audio recording of the instructor, PowerPoint slides, videos or any other class content or material, is strictly prohibited unless otherwise specifically authorized in writing.