Student Information and Release of Liability

STUDENT TRAINING ATTENDANCE RECORD

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone

Email *

Date of Birth *

Occupation / Employer *

Emergency Contact: Name and Phone Number *

How did you hear about PFC? *

May we use photos, video, or written comments taken during this training or event in future promotional efforts? *

I registered for this training or event via:

Payment Method

Payment Status

RELEASE OF LIABILITY AND ASSUMPTION OF THE RISK

Course / Event Date *

Name of Course / Event *

I understand that I am participating in organized small arms, concealed carry, close-quarter combat/physical defense, specialized training and/or tactical training event or course of instruction (Course), using the training facilities for an event, and/or participating as a spectator. Participation and/or observation of such a Course or event exposes me to potential major and minor injuries including, but not limited to, gunshot wounds, blunt force trauma, lacerations, soft tissue injuries, injuries caused by back-splatter from steel targets, broken bones, concussions, etc. *

Initials

I am participating in this Course on my own free will and FULLY UNDERSTAND AND ACCEPT the inherent risks associated with this training I choose to be involved in; and as a result, I, my family and heirs WILL HOLD HARMLESS AND FOREVER RELEASE the training facility, training facility owner, Progressive F.O.R.C.E. Concepts, L.L.C. training organization (the Training Organization), and Training Organization Instructor(s), including but not limited to Stephen J. Krystek, owners, associates, affiliates, immediate family, extended family and heirs from any liability whether intentional or unintentional acts or actions, injuries or death to my person, injuries or death to another person, or damage to property resulting from my participation in training and firing range use. *

Initials

If I must use a Blackhawk Serpa holster or any holster that utilizes a trigger finger actuated retention mechanism, I do so of my own free will, fully recognizing and accepting the risks and hazards associated with this equipment. Furthermore, I WILL NOT make any legal claims of damage or losses resulting from injuries sustained during this or any other training or special event conducted by Progressive F.O.R.C.E. Concepts, LLC, or initiate any legal action of any kind against Progressive F.O.R.C.E. Concepts, LLC now or in the future. *

Initials

I understand the local environmental conditions are unforgiving, and further, hydration is my responsibility. Breaks to consume water have been provided by the Facility, Training Organization, and or Instructors. Furthermore, I, my family and heirs WILL HOLD HARMLESS AND FOREVER RELEASE the training facility, training facility owner, the Training Organization (Progressive F.O.R.C.E. Concepts, LLC), and Training Organization Instructor(s), including but not limited to Stephen J. Krystek, owners, associates, affiliates, immediate family, extended family and heirs from any liability resulting from my future actions as a result of the training obtained during this course. *

Initials

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is reported to be extremely contagious. The State of medical knowledge is evolving, but the virus is believed to spread from person-to-person contact and or by contact with contaminated surfaces and objects, and even possibly in the air. People reportedly can be infected and show no symptoms and therefore spread the disease. The exact methods of spread and contraction are unknown, and there is no known treatment, cure, or vaccine for COVID-19. Evidence has shown that COVID-19 can cause severe and potentially life-threatening illness and even death.

Progressive F.O.R.C.E. Concepts, L.L.C. cannot prevent you from becoming exposed to, contracting, or spreading COVID-19 while utilizing Progressive F.O.R.C.E. Concepts, L.L.C. services or premises. While P.F.C. has taken multiple steps to prevent the spread of COVID-19 within its facilities, it is not possible to prevent against the presence of the disease. Therefore, if you choose to utilize Progressive F.O.R.C.E. Concepts, L.L.C. services, and or enter onto Progressive F.O.R.C.E. Concepts, L.L.C. premises, you accept any residual risk of exposure to and/or increasing your risk of contracting or spreading COVID-19.

ASSUMPTION OF RISK: I have read and understood the above warning concerning COVID-19. I hereby choose to accept the risk of contracting COVID-19 for myself in order to utilize Progressive F.O.R.C.E. Concepts, L.L.C. services, and enter Progressive F.O.R.C.E. Concepts, L.L.C. premises. These services are of such value to me that I accept the risk of being exposed to, contracting, and or spreading COVID-19 in order to utilize Progressive F.O.R.C.E. Concepts, L.L.C. services and premises in person [Rather than arranging for an alternative method of enjoying the same services virtually (e.g., videoconference).] *

I have no preexisting medical conditions that prevent me from attending and participating in this training course or event. *

Initials

By my signature on this document, I state that I have no criminal history preventing me from possessing a firearm and am not wanted for questioning or arrest by any law enforcement or government agency. I further state that I have no history of mental illness or substance abuse, and that I am not currently under, nor will I be under, the influence of alcohol or other controlled substance while participating in this training or special event. I understand that my participation in a training course or event may be terminated at any time if my actions are not deemed safe or appropriate by the training staff. I agree to follow and abide by ALL safety rules and procedures outlined by the training staff and will immediately report any sustained injuries. *

Initials

I can provide one or more of the following on the first day of the training course or event if required: Picture ID / CCW / Background Check Documentation / Other Training Qualification Identification *

Initials

I fully understand this document I have read, agree to abide by all of the above conditions, and understand this document is valid for and applies to the duration of the above-entitled training course of instruction or special event from the beginning date to the end date: *

Today's Date *

GDPR Agreement *

I consent to having this website store my submitted information so they can respond to my inquiry.

Email *