Self-Defense & Emergency Preparedness Clinic

General Information
Name*
First Last
Physical or Health Conditions we should be aware of?*
Do you have any physical or health conditions we should be aware of so that we can maximize your training experience?
- Yes
- No
Please provide any information that may be helpful regarding your physical or health considerations
Parent/Guardian Information
Name*
First Last
Phone Number*
Preferred Email Address*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Emergency Contact Information
Emergency Point of Contact*
The person to call in event of an emergency
First Last
Your Relationship to Emergency Point of Contact*
Emergency Contact Phone Number*
Payment
Select Your Option*
OPTION 1: Preparation & Reality, Avoidance & Escape, Run-Hide-Fight Method, Survive the Unthinkable, and Basic First Aid. OPTION 2: Includes everything in Option 1 along with the Introduction to the Common Handgun curriculum.
Total
$0.00

General Information