Class Registration Form

We have two easy ways for you to pay. Either provide the credit card information below and we will run your card (Visa, Mastercard and Discover only) or select PayPal in "Credit Card Options" below, and AFTER clicking the "submit" below, click on the yellow "Pay Now" button on the page to which you will be taken. STUDENT ENROLLMENT INFORMATION
I want to enroll in (Please specify the class date for monthly CHL classes.)
Name:	(first middle last)
Add. Family / Friends:	Add any additional family members or friends here that will attend training class.
Address:
City/State/Zip:
Telephone:		This is my number.
Email Address:
Texas Drivers License: (CHL courses only)
Texas CHL: (Advanced courses only)
Credit Card No:
Exp. Date:
Credit Card Type:
Firearm experience:
Describe any previous training below.
EMERGENCY INFORMATION: Since our inception we have never had a serious injury or medical emergency during a course. This information is kept private and is only used to identify students that may need extra attention or assistance during class, and to assist first responders in the event of a medical emergency. Completion of this part of the form is optional.
Person to contact:
Relationship:			Telephone:
Doctor:			Medical conditions (select all that apply):
please include any information here that might be helpful in a potentially life threatening situation (bee sting, seizure, etc.)
You can use the space below to ask any questions you have about specific classes or our program in general.
Select the appropriate fee category:
Enter Amount To Be Charged : $ A $25 fee will be assessed for processing refunds or cancellations.
Privacy notice: We do not share or sell contact information to 3rd parties. All information is strictly used for enrollment purposes through Safe Gun Academy.