+1 (719) 937-4141

info@leadfaucettactical

THANK YOU FOR YOUR PURCHASE!

Please fill out the Safety Waiver Form below, before your class.

First Name *

Last Name *

Email *

Phone *

This number will be used for text reminders and course updates (Make sure this number can receive SMS messages)

Is this a Private or Open LE class? *

Course Type *

Start Date *

End Date *

In consideration of being permitted to participate in firearms instruction, shooting activities, self-defense and or combat training, or other training or instruction involving Dan Brokos, and Lead Faucet Tactical LLC. .

I, on behalf of myself and or my personal representatives, assigns, heirs, and next of kin.

Acknowledge *

that shooting, self-defense and combat related activities have inherent risks, hazards, and dangers for anyone that cannot be eliminated. I understand that these risks, hazards and dangers include without limitation, the risk of handling firearms and being near others that have firearms in their possession, the risk of ear damage, eye damage, burn hazards, the risk of injury from ammunition, lead poisoning, the risk of tripping, stumbling while carrying equipment, the risk of serious bodily injury, including permanent disability, paralysis and death.

I Fully Understand:

Acknowledge *

the risks, hazards and dangers as described above. I understand I have responsibilities. My participation in this activity is purely voluntary. No one is forcing me to participate in spite of the risks. I am voluntarily using the services of Mr. Dan Brokos, with full knowledge of the inherent risks. These risks and dangers may be caused by me and or my own actions, or inactions, or the actions or inactions of others participating in the activity. There may be other risks and social and economic losses either not known, to me or not readily foreseeable, at this time.

I Hereby accept and assume

Acknowledge *

all such risks, known and unknown, and assume all responsibility for the losses, costs, and or damages following such injury, disability, paralysis, or death, even if caused, in whole or in part, by the negligence of other intentional or other unintentional acts and omissions of the “RELEASED PARTIES” named below.

I Hereby release,

Acknowledge *

discharge, and covenant not to sue Lead Faucet Tactical LLC, Mr. Dan Brokos, Jessica Brokos, their heirs, their respective agents, administrators, directors, assistants, officers, volunteers, and employees if applicable, other participants, sponsors, advertisers, and if applicable owners or lessors of property and premises on which the activity takes place. (Each considered one of the ‘RELEASED PARTIES’ herein), from all liability, claims, demands, losses, or damages on my account caused or alleged to be caused in whole or in part by the intentional or unintentional acts or negligence of a “RELEASED PARTY,” or otherwise, including negligent rescue operations, I further agree that if, despite the RELEASE AND WAIVER, I or anyone on my behalf, makes a claim against any of the “RELEASED PARTIES,”, I WILL INDEMNIFY, SAVE, AND HOLD HARMLESS EACH OF THE “RELEASED PARTIES’ from any litigation expenses, attorney fees, loss, liability, damage, or cost which may incur as the result of such claim.

I have read this agreement,

Acknowledge *

fully understand its terms, understand that I have given up substantial rights by signing it and have signed freely and without any inducement or assurance of any nature and intend it to be a complete and unconditional release of liability to the greatest extent by law, and agree that if any portion of this agreement is held to be invalid the balance, notwithstanding, shall continue in full force and effect.

Please confirm each Cardinal Rule of Gun Safety in the area below:

Know the condition of your weapon at all times. (Otherwise treat all guns as if they are loaded) *

I affirm the statement above

Never point the weapon at anything that you do not want to destroy, kill, replace, or pay for. *

I affirm the statement above

KEEP YOUR FINGER OFF THE TRIGGER AND ALONGSIDE THE FRAME UNTIL YOU HAVE MADE THE CONSCIOUS DECISION TO FIRE THE WEAPON *

I affirm the statement above

In addition:

I, , hereby certify that I am a U. S. citizen.

I, , hereby certify by my digital or actual signature that I have no criminal convictions that prevent me from legally possessing, owning or purchasing firearms.

I, , further certify that I have not been convicted of any felony or misdemeanor crime of domestic violence, and am under no injunction or order of protection which would prevent me from being in possession of a firearm.

I, , further certify that I have no official or unofficial history of mental illness or substance abuse.

I, , further certify that I have never been affiliated with or belong to a gang or other illegal organization involved or engaged in any illegal activities. This included international or domestic terrorist organizations.

If any course or related activity (including travel) takes place in California, or any other state with licensing, registration or other laws, rules or regulations relating to firearms, weapons or other equipment, or relating to my participation in a course or related activities, I certify that I, and any and all of my equipment to be used in connection with the course or training, are and shall be in compliance with such laws, rules and regulations.

This certification expressly covers any California law dealing with “assault weapons”.

I, , authorize agents of Mr. Daniel Brokos, or Lead Faucet Tactical LLC., to investigate the validity of my statements by any means necessary. Failure to comply will constitute non–compliance with Lead Faucet Tactical LLCs, training policy and may result in removal from training course, or being disallowed to attend.

Signature *

Clear

Today's Date *

In some classes the student may elect to use his/her personal vehicle as a shooting platform. Allowing himself, or others in the class to shoot from inside or around the vehicle. By signing below the student exempts Lead Faucet Tactical LLC., and its owners, heirs, executors from any responsibility for damages that may incur to his vehicle or anyone riding in the vehicle, or shooting around the vehicle.

Vehicle Make *