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This waiver is for those people taking a Concealed Handgun Permit Course.

NOLATAC Firearms Training &St. Bernard Indoor Shooting Center

INDEMIFICATION AND HOLD HARMLESS AFFIDAVIT

I am taking / have taken a handgun course which consists of approximately (9) hours of verbal instruction, video instruction, and a live fire examination consisting of 36 rounds (12@ 6-ft, 12 @ 10-ft, and 12@ 15-ft) for the purpose of application for the Louisiana Concealed Handgun Permit.

I am taking / have taken training that involves the use or training in the use of, firearms, physical activity, legal discussion, and/or use of specific equipment. I agree that none of the parties listed below can be held responsible for my safety or actions while engaged in these events.

I have read the rules and regulations handbook or have been furnished information on how to obtain it for future reference as provided by the Louisiana Department of Public Safety and Corrections. I understand it and agree to abide by all laws and rules contained within upon receiving my permit from the state of Louisiana.

I agree to indemnify and hold harmless NOLATAC LLC, Brannon LeBouef, St Bernard Indoor Shooting Center, 212 Aycock Range Operations LLC, 212 Aycock LLC, any agents, instructors, staff, employees, volunteers, partners, managers, other students, or any other individual associated with the training I am taking in any capacity, against any and all liability, claims, actions, fines, losses, lawsuits, injuries, or action of any kind or nature to include but not limited to costs and attorney fees, in any manner arising from or connected to the training, application, approval, or disapproval of my Louisiana Concealed Handgun Permit. I also agree to hold harmless the above mentioned parties from any liability as a result of my application of the training, skills, techniques, tactics, advice, use of force up to and including deadly force, or use of a firearm.

I understand that this course is potentially video, audio, and photo recorded. By remaining in the class, I consent to such recording and understand all rights and privileges associated with the content of such recording is the sole property of NOLATAC LLC and The St Bernard Indoor Shooting Center.

I understand that there are inherent risks with firearms training and that no instructor, including the ones held harmless in this agreement, could possibly guarantee 100% safety from injury. Only I can make sure I follow all safety rules and instructor directions to maximize my safety and the safety of others.

I understand that if I at any time fail to follow the safety rules, instructor directions, or in any other way or manner pose a risk to others, or myself I may be asked to leave the class without a refund.

I understand that the legal information being presented here is NOT LEGAL ADVICE. Only a licensed attorney can give legal advisement. What I am receiving is simply a layman’s opinion of the current legal elements pertaining to carrying a concealed firearm and the use of force based on their own personal experiences and education, none of which constitutes actual legal advice. It is imperative, as I have been instructed in the class, to seek and retain the services of a qualified attorney in the event I find myself needing legal advice.

I understand that while they will be repeated and explained in depth, the basic firearms safety rules that I am responsible for following from this point forward are:

1. Treat every firearm as if it were loaded.

2. Keep your finger straight and off the trigger until ready to fire.

3. Never point a firearm at anything you are not willing to destroy or kill.

4. Know your targets foreground, background, and surrounding in a 360 degree field.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Email

Email *
Are you taking this to get your Permit for the first time or is this a Renewal for you?*
First Time (New Applicant)
Renewal
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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