Concealed Firearm Permit Application

Not an NRA Approved Course

Disclaimer: This is course is conducted under the guidelines of the Utah Department of Public Safety, Bureau of Criminal Identification, Concealed Firearms; following the minimum training curriculum for the State of Utah Concealed Firearm Permit (CFP) and involving a live-fire training exercise. It is taught by an NRA Certified Training Counselor, Instructor and/or team of NRA Certified Instructors. It is not an NRA Approved Course and no NRA certificate or credentials are given at the completion of the training. You will receive certification of having completed the required State of Utah training for your Utah CFP application, along with a completed and certified CFP application, completed fingerprint card and a photograph.

Terms & conditions: Collecting Sensitive Information. This form collects some sensitive information such as your driver license number. The data and information collected on this form is only used for the generation of the CFP application that is submitted to the State of Utah, Department of Public Safety, Bureau of Criminal Identification (BCI) for the sole purpose of processing your application, completing a criminal background check, and for submission of your fingerprint cards to the Federal Bureau of Investigation (FBI). Your data will not be used for any other purpose.

Full Name*

First NameMiddle NameLast NameSuffix

Previous or Maiden Name

First NameMiddle NameLast NameSuffix

E-mail*

Phone*

Area CodePhone Number

Alt.Phone

Area CodePhone Number

Birth Date*

MonthDayYear

*** You must enter a State of Birth if you were born in the United States. Leave State of Birth blank and enter the Province or Prefecture of Birth if you were born in a Foreign Country. ***

State of Birth

Province of Birth

Country of Birth*

Alien Registration Number:

Current Residence*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Mailing Address (if different from street address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Driver License #*

License State*

Height Feet*

Height Inches*

Weight*

Eye Color*

Hair Color*

SEX*

RACE*

CITIZENSHIP*

Criminal History*

	Yes	No
Have you ever been adjudicated as a juvenile, or convicted, as an adult, of a felony?
Have you ever been convicted of a crime of violence?
Have you ever been convicted of an offense involving the use of alcohol? (i.e. DUI/DWI, alcohol related reckless, unlawful use of alcohol, etc.)
Have you ever been convicted of the unlawful use of narcotics or other controlled substances?
Have you ever been convicted of any offense involving moral turpitude? (i.e., theft, criminal mischief, sex crimes, etc.)
Have you ever been convicted for any offense involving domestic violence?
Have you ever been adjudicated as mentally incompetent?
Are you currently subject to a court sanctioned protective order?
Have you ever been dishonorably discharged from the armed forces?

If you answered [YES] to any of the above questions, please explain here:

FIREARM SHOOTING RANGE RELEASE FORM

Adult Participant. As an attendee at a firearms shooting range operated by the Wahsatch Shooters Association ("WSA Shooting Range"), I do hereby agree to the following:

Agreement to abide and follow:*

	Agree fully.	Agree.	Do not agree.	Does not apply.
I agree to follow all posted rules and regulations of the Shooting Range.
I agree to follow all directions of the Range Safety Officers and NRA Pistol Instructors.
I certify that I am knowledgeable in the safe handling, use and operation of all equipment present at the Shooting Range, including firearms and associated safety equipment.
I have, prior to engaging in any activities at the Shooting Range, determined that all shooting equipment, ammunition, and corresponding items to be utilized at the Shooting Range are in good condition and are suitable for the activities contemplated herein.
I understand that there are risks associated with my attendance and participation in activities at the Shooting Range, and that regardless of the precautions I may take, including but not limited to the wearing of various types of protective gear, that I could experience serious injury and/or death as the result of my attendance and participation.
I am familiar with the risks of attending and participating in activities at the Shooting Range, and being of sound mental and physical condition, voluntarily assume all risks associated with my attendance and participation.

I agree to protect, indemnify, save and hold harmless the Wahsatch Shooters Association (WSA), its Executive Board, agents, volunteers, and all participating sponsor organizations, from and against all claims, demands, damages, and causes of action of every kind or character arising because of, for, out of, or in any way connected with my attendance at the WSA Shooting Range, unless caused by the sole negligence of the Wahsatch Shooters Association. I agree to defend all suits brought upon such claims and pay all costs and expenses incidental thereto, but the Wahsatch Shooters Association shall have the right, at its option, to participate in the defense incidental thereto without relieving me of any obligation hereunder.

*All information collected is protected under the Government Records Access Management Act. Signing this participation form allows the WSA to use photos for the promotion of the Wahsatch Shooters Association Range. Individual names will not be used without the express, written permission from the parent and/or guardian. I understand that on occasion the Wahsatch Shooters Association uses photos on its website and WSA-related publicity. I also understand that the WSA will only use group photos of youth and will never identify them by name.

Enter the word as it is shown:*