Name

First Name

Last Name

Date

Please select today's date

YYYY

Year of Birth

Ethnicity

Mailing Address

Please enter an address where you can receive mail below. We will not send you any marketing materials without your explicit prior consent.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address

Telephone Number

(###)

###

####

Why would you like to attend the workshop?

Participation for the entire period of instruction is mandatory. By checking the box below, you are confirming you will be able to attend the entire 8 hours of instruction:

Confirmed

Are you currently or were you ever a Law Enforcement officer in any capacity?

On occasion, workshops are video-recorded. Your checking the box below (as well as participating in the class) confirms your agreement to allow for your image to be used in promotional videos for the class.

I acknowledge that video may be recorded during classes, and accept that I may appear in videos for the class

There are graphic videos shown in the class that include adult content and language. This includes physical violence and vulgarity. Do you still wish to participate in the class if offered the opportunity?

human… class facilitators foster a positive and civil learning environment. Therefore, a strict code of conduct exists prohibiting negative behavior, which is viewable by clicking the "Code of Conduct" link at the bottom of this page. Do you agree to abide by this code of conduct for the duration of the class?

Lunch is hosted. Do you have any food allergies or prohibitions? If so, please list/describe them below

Please enter your name below which will serve as a digital signature, indicating that you are completing the information above for yourself, and that all of the above information is true and correct, to the best of your knowledge:

First Name

Last Name

participant application