Virginia Pistol Waiver Form
The waiver form shown below must be completed and signed in front of your instructor on the day of your Virginia Pistol class.
The undersigned (hereinafter referred to as the “Student”), for himself or herself and members of their family, in consideration of the participation in shooting instruction and/or training on the property of: _______________________________________________________________________, do hereby release and discharge NRA Certified Pistol Instructor Jimmy D. Johnson of Virginia Pistol LLC, and______________________________________ at the property on which such shooting instruction and/or training occurs and all persons and parties involved in the conduct and supervision of such shooting and training activities from any and all liability and claims of any nature by the undersigned and/or members of his or her family arising from any injury to persons or damage to property occurring during said shooting instruction an/or training while the undersigned and/or members of his or her family are on the owner's property. The undersigned further agrees to abide by rules of the range and the range officers and the instructors while the undersigned is on the owner's property, and will endeavor to participate in said shooting activities on the range with all due safety and proper conduct.
STUDENT, FOR HIMSELF AND HIS FAMILY MEMBERS, HEREBY RELEASES, DISCHARGES AND HOLDS HARMLESS JIMMY D. JOHNSON, VIRGINIA PISTOL LLC, AND ________________________________ FROM ANY AND ALL CLAIMS, CAUSES OF ACTION (WHETHER LEGAL OR EQUITABLE), DEMANDS, LIABILITY AND DAMAGES ARISING FROM JIMMY D. JOHNSON’S PROVIDING SHOOTING INSTRUCTION TO STUDENT, INCLUDING WITHOUT LIMITATION FOR ANY NEGLIGENCE, ACT OR OMISSION IN CONNECTION WITH PROVIDING SUCH INSTRUCTION, AND INCLUDING WITHOUT LIMITATION ANY CLAIMS FOR INJURY TO THE STUDENT AND/OR THE STUDENT’S PROPERTY, AND/OR FOR INJURY TO ANY THIRD PERSON OR THIRD PERSON’S PROPERTY, CAUSED OR ALLEGED TO HAVE BEEN CAUSED BY THE STUDENT’S USE OF OR FAILURE TO USE A FIREARM IN ANY CIRCUMSTANCE.
STUDENT, FOR HIMSELF AND HIS FAMILY MEMBERS, RELEASES, DISCHARGES AND HOLDS HARMLESS JIMMY D. JOHNSON, VIRGINIA PISTOL LLC, AND ______________________________ FROM ANY AND ALL CLAIMS, CAUSES OF ACTION (WHETHER LEGAL OR EQUITABLE), DEMANDS, LIABILITY AND DAMAGES FOR NEGLIGENCE, CONTRIBUTION, INDEMNITY, AND/OR ANY OTHER THIRD PARTY CLAIMS HOWEVER DENOMINATED, ARISING OUT OF THE STUDENT’S USE OF OR FAILURE TO USE A FIREARM AT ANY TIME FOR ANY PURPOSE.
STUDENT WARRANTS AND REPRESENTS THAT HE/SHE HAS ACTUAL AUTHORITY FROM HIS/HER FAMILY MEMBERS TO EXECUTE THE ABOVE RELEASES ON THEIR BEHALF AND ACKNOWLEDGES THAT THIS IS A MATERIAL REPRESENTATION RELIED UPON BY JIMMY D. JOHNSON, VIRGINIA PISTOL LLC, AND ___________________________________ IN DECIDING TO PROVIDE STUDENT WITH SHOOTING INSTRUCTION.
STUDENT HEREBY EXPRESSLY ACKNOWLEDGES AND UNDERSTANDS THAT THIS TRAINING COURSE DOES NOT, AND DOES NOT PURPORT TO, INSTRUCT THE STUDENT ON THE CIRCUMSTANCES UNDER WHICH THE USE, OR THE THREAT OF USE, OF LETHAL OR POTENTIALLY LETHAL FORCE (WHETHER WITH A FIREARM OR OTHERWISE) IS LEGALLY JUSTIFIED.
STUDENT HEREBY EXPRESSLY ACKNOWLEDGES AND UNDERSTANDS THAT HIS OR HER USE, OR THREAT OF USE, OF LETHAL OR POTENTIALLY LETHAL FORCE (WITH A FIREARM OR OTHERWISE) MAY RESULT IN SEVERE CIVIL LIABILITY AND/OR CRIMINAL CULPABILITY.
STUDENT HEREBY EXPRESSLY ACKNOWLEDGES AND UNDERSTANDS THAT THIS TRAINING COURSE DOES NOT, AND DOES NOT PURPORT TO, INSTRUCT THE STUDENT ON THE MANY AND VARIED FEDERAL, STATE AND LOCAL LAWS AND REGULATIONS GOVERNING THE ACQUISITION, POSSESSION, TRANSFER AND/OR USE OF FIREARMS.
STUDENT HEREBY EXPRESSLY ACKNOWLEDGES AND UNDERSTANDS THAT COMPLETING THIS COURSE DOES NOT ENTITLE THE STUDENT TO CARRY A CONCEALED WEAPON. IT IS GENERALLY A VIOLATION OF VIRGINIA CRIMINAL LAW TO CARRY A CONCEALED WEAPON UNLESS ONE HAS A VALIDLY ISSUED PERMIT TO DO SO. THE LAWS OF THE COMMONWEALTH OF VIRGINIA DETERMINE WHEN ONE IS PERMITTED TO CARRY A CONCEALED WEAPON IN VIRGINIA. THE CIRCUIT COURTS OF THE COMMONWEALTH OF VIRGINIA ARE RESPONSIBLE FOR APPLYING VIRGINIA LAW TO DETERMINE TO WHOM A PERMIT TO CARRY A CONCEALED WEAPON IS ISSUED AND THOSE COURTS ARE RESPONSIBLE FOR ISSUING SUCH PERMITS.
STUDENT HEREBY EXPRESSLY ACKNOWLEDGES AND UNDERSTANDS THAT THE ACQUISTION, POSSESSION, TRANSFER AND USE OF FIREARMS ARE REGULATED BY FEDERAL, STATE AND LOCAL LAWS AND REGULATIONS. ANY PERSON INTENDING TO ACQUIRE, POSSESS, TRANSFER AND/OR USE A FIREARM SHOULD TAKE AFFIRMATIVE STEPS TO INFORM HIMSELF OR HERSELF OF THE REQUIREMENTS OF SUCH LAWS AND REGULATIONS.
No illegal or controlled drugs will be allowed on the property. No alcohol or intoxicated persons will be allowed in, around, or near the range. No loaded firearms of any description or caliber or gauge will be permitted on the owner's property and shooting range except when in the ready firing position on the firing line. Upon leaving the firing line, all firearms will be unloaded and it will be the responsibility of the holder of said firearm to be sure it is unloaded and safe before leaving the firing line. The undersigned also agrees not to shoot at any living animal while on said property.
Hearing and eye protection are mandatory for everyone on or near the firing range.
I certify that I will use the skills and knowledge gained here only in or for lawful sporting activities and lawful self-defense, and that I will conduct myself in such a manner as not to bring the sport of shooting into disrepute.
This release and discharge shall be binding upon and inure to the heirs, personal representatives and the assignees of the parties.
Student’s Signature: __________________________________________________________________________
Print Full Name: _____________________________________________________________________________
Street Address:_______________________________________________________________________________
City, State & Zip: ____________________________________________________________________________
E-Mail Address: ____________________________________________ Date of Birth: ___________________
Home Phone: ____________________ Cell Phone: __________________ Work Phone: __________________
Witness Signature: ___________________________________________________________________________
Witness Name & Address (print): _______________________________________________________________
____________________________________________________________________________________________
NRA Instructor Name: __________________________NRA Number: _____________ Exp. Date: ___________
"Practice does NOT make perfect! Only quality training combined with perfect practice makes perfect....and it could save your life!" - (Virginia Pistol Chief Instructor Jim Johnson )