Application Form - Prometheus Tactical LLC

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If you have shopped with us before, please enter your details below. If you are a new customer, please proceed to the Billing section.

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You must be logged in to an existing account to sign up for classes. If you do not have an account, fill out the application form below to create one.

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1Applicant Information

2Medical & Emergency

3Waivers

4Create Account

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile Phone

Date of Birth*

Are you a US citizen?*

If no, what is your residency status?*

Gender*

Height*

Weight*

Eye Color*

Do you hold a domestic or international valid driver's license?*

Yes

Have you ever been convicted of a felony?*

Yes

Might you have any outstanding warrants?*

Yes

Have you ever been convicted of domestic violence in any U.S. jurisdictions?*

Yes

Have you ever had a firearms identification card refused or revoked?*

Yes

Do you have a Firearms identification card for the state, which you reside, or an out of state Firearms identification card? If so, a copy will be required to be submitted with this application.*

Yes

N/A

Attach Copy Here*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 8 MB.

Unfortunately, we are unable to register you for a class at this time.

Are you currently or previously LEO or Military?*

Yes

If yes, will you be training with a service gun/gear or your personal gun/gear?*

Yes

Do you have any firearms training experience?*

Yes

What is your level of experience/what course(s) have you taken?

Please list out the firearms you have had prior training with:

Will you consent to a background investigation?*

Yes

What is your highest level of education?*

What valid (unexpired) certifications do you hold relative to firearms, martial arts, combat training, medical or emergency services training?

Do you currently or have in the past worked in a security field and/or related area?*

Yes

If so, please list in what capacity*

Please type your expectations for this firearms training course in the box below.*

What is your blood type?*

Please list any allergies, including seasonal

Do you have or will you need medical clearance to participate in any shooting activity?*

Yes

Are you currently covered by medical insurance?*

Yes

Have you ever been hospitalized for any mental/psychiatric reasons?*

Yes

Do you use any narcotic medications or controlled substances?*

Yes

Do you have any mental and/or physical condition, which would make it difficult to use a firearm?*

Yes

Do you have any health concerns that may affect your ability to do physical activity or require any special accommodations?*

Yes

Unfortunately, we are unable to register you for a class at this time.

IN CASE OF EMERGENCY

Emergency Contact Name*

Relationship to Applicant*

Emergency Home Phone

Emergency Cell Phone

If you are or suspect yourself to be pregnant, I strongly recommend you refrain from any physical shooting activity due to possible lead contamination.

RELEASE OF LIABILITY

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

In exchange for participation in the activity of Hand-to-hand combat, knife defense, active shooter training, basic to advanced shooting and tactical training organized by Prometheus Tactical LLC, or use of the property, facilities and services of Prometheus Tactical LLC, I agree for myself and (if applicable) for the members of my family, to the following: 1) AGREEMENT TO FOLLOW DIRECTIONS: I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by Prometheus Tactical LLC, or the employees, representatives or agents of Prometheus Tactical LLC. 2) ASSUMPTION OF THE RISKS AND RELEASE: I recognize that there are certain inherent risks associated with the above-described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge Prometheus Tactical LLC for injury, loss or damage arising out of my or my family's use of or presence upon the facilities of Prometheus Tactical LLC, whether caused by the fault of myself, my family, Prometheus Tactical LLC or other third parties. 3) INDEMNIFICATION: I agree to indemnify and defend Prometheus Tactical LLC against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of Prometheus Tactical LLC. 4) FEES: I agree to pay for all damages to the facilities of Prometheus Tactical LLC caused by any negligent, reckless, or willful actions by me or my family. 5) APPLICABLE LAW: Any legal or equitable claim that may arise from participation in the above shall be resolved under New Jersey law. 6. NO DURESS: I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that Prometheus Tactical LLC has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement. 7) ARM'S LENGTH AGREEMENT: This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity. 8) ENFORCEABILITY: The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement. 9) EMERGENCY CONTACT: In case of an emergency, please contact my EMERGENCY CONTACT indicated on this sign-up page.*

I HAVE READ THE RELEASE OF LIABILITY WAIVER AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY CHECKING THIS BOX AFTER READING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

MEDIA WAIVER & PHOTO / VIDEO RELEASE

I grant permission to Prometheus Tactical LLC and its agents and employees the irrevocable and unrestricted right to reproduce the photographs and or videos taken of me for the purpose of publication, promotion, illustration, advertising or trade in any manner or in any medium. I hereby release Prometheus Tactical LLC and its legal representatives for all claims and liability relating to said images, videos and their editing. I furthermore grant permission to use my statements that were given during my interview, guest lecture and or presentation, with or without my name, for the purpose of advertising and publicity without restriction. I also, waive my right to any compensation for how my images and or videos are used by Prometheus Tactical LLC.*

I HAVE READ THE MEDIA WAIVER & PHOTO / VIDEO RELEASE AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY CHECKING THIS BOX AFTER READING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

OPT OUT

AGE ACKNOWLEDGEMENT CHECKBOX*

I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18

The information provided within this application will be used for the purposes to determine if you are legally allowed under NJ State law to handle firearms. As well as to create a personalized training curriculum to meet the needs of individuals and or group training. Prometheus Tactical takes all reasonable steps to protect personal information from misuse, loss and unauthorized access, modification or disclosure using physical, electronic and procedural safeguards. To keep electronic information secure, we use a range of security measures, such as restricting access to users who have a valid username and password. I hereby certify that all the answers in this application are true and complete and that any false or misleading information provided by in this application may be grounds for a refusal to be trained. I understand and agree that, if I train under Prometheus Tactical, I will follow all safety rules and range policies reviewed and set forth by Prometheus Tactical.

BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS

ACKNOWLEDGEMENT SIGNATURE*

Email*

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Don’t have an account? Fill out the application form below and you will be able to complete your checkout and sign up for future classes at your convenience.

"*" indicates required fields

1Applicant Information

2Medical & Emergency

3Waivers

4Create Account

Name*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Mobile Phone

Date of Birth*

Are you a US citizen?*

If no, what is your residency status?*

Gender*

Height*

Weight*

Eye Color*

Do you hold a domestic or international valid driver's license?*

Yes

Have you ever been convicted of a felony?*

Yes

Might you have any outstanding warrants?*

Yes

Have you ever been convicted of domestic violence in any U.S. jurisdictions?*

Yes

Have you ever had a firearms identification card refused or revoked?*

Yes

Do you have a Firearms identification card for the state, which you reside, or an out of state Firearms identification card? If so, a copy will be required to be submitted with this application.*

Yes

N/A

Attach Copy Here*

Accepted file types: jpg, jpeg, gif, png, pdf, doc, docx, Max. file size: 8 MB.

Unfortunately, we are unable to register you for a class at this time.

Are you currently or previously LEO or Military?*

Yes

If yes, will you be training with a service gun/gear or your personal gun/gear?*

Yes

Do you have any firearms training experience?*

Yes

What is your level of experience/what course(s) have you taken?

Please list out the firearms you have had prior training with:

Will you consent to a background investigation?*

Yes

What is your highest level of education?*

What valid (unexpired) certifications do you hold relative to firearms, martial arts, combat training, medical or emergency services training?

Do you currently or have in the past worked in a security field and/or related area?*

Yes

If so, please list in what capacity*

Please type your expectations for this firearms training course in the box below.*

What is your blood type?*

Please list any allergies, including seasonal

Do you have or will you need medical clearance to participate in any shooting activity?*

Yes

Are you currently covered by medical insurance?*

Yes

Have you ever been hospitalized for any mental/psychiatric reasons?*

Yes

Do you use any narcotic medications or controlled substances?*

Yes

Do you have any mental and/or physical condition, which would make it difficult to use a firearm?*

Yes

Do you have any health concerns that may affect your ability to do physical activity or require any special accommodations?*

Yes

Unfortunately, we are unable to register you for a class at this time.

IN CASE OF EMERGENCY

Emergency Contact Name*

Relationship to Applicant*

Emergency Home Phone

Emergency Cell Phone

If you are or suspect yourself to be pregnant, I strongly recommend you refrain from any physical shooting activity due to possible lead contamination.

RELEASE OF LIABILITY

READ CAREFULLY – THIS AFFECTS YOUR LEGAL RIGHTS

I HAVE READ THE RELEASE OF LIABILITY WAIVER AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY CHECKING THIS BOX AFTER READING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

MEDIA WAIVER & PHOTO / VIDEO RELEASE

I HAVE READ THE MEDIA WAIVER & PHOTO / VIDEO RELEASE AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY CHECKING THIS BOX AFTER READING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.

OPT OUT

AGE ACKNOWLEDGEMENT CHECKBOX*

I ACKNOWLEDGE THAT I AM OVER THE AGE OF 18

BY CHECKING THIS BOX, I ACKNOWLEDGE THAT I HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE STATEMENTS

ACKNOWLEDGEMENT SIGNATURE*

Email*

Enter Email Confirm Email

Password*

Enter Password Confirm Password