City of Columbus

Civilian Response to Active Shooter Events

First Name: 

Last Name: 

Address: 

Address: 

City: 

State: 

Zip: 

Phone: (xxx-xxx-xxxx) 

Email: 

Age: 

 I would like to schedule a class for a group of 20 or more people.

 I am an individual who wants to join a scheduled class. 

What is your preferred class time? 

How did you hear about our program? 

Print Name: 

Date: (xx-xx-xxxx) 

 By submitting this form, I agree that all information provided is true, correct and complete. The electronic signature on the form is authentic and signed by person named on the form.