C A First Aid

CERTIFICATE OF SUCCESSFUL COMPLETION OF GUARD TRAINING

[Statutory Authority: T.C.A. § 62-35-118, Administrative Rule 0780-05-02-.15] TYPE OF REGISTRATION: CHECK ALL APPROPRIATE BOXES

UNARMED INITIAL ARMED INITIAL UNARMED RENEWAL ARMED RENEWAL ADD / CHANGE WEAPON ADD CLASSIFICATION / / Last Name First Name Middle Initial Social Security Number Registration #

Initial – Four (4) Hours General Guard Training Date Score

Initial – Eight (8) Hours Classroom Firearms Training Date Score Initial – Four (4) Hours Marksmanship Training

1. Weapon Make Model Caliber Date Score

RENEWALS:

Renewal – Classroom UG Date AG Date Score

Renewal – Firing Range

1. Weapon Make Model Caliber Date Score

ADDITIONAL WEAPON INFORMATION:

Add / Change Weapon

2. Weapon Make Model Caliber Date Score

3. Weapon Make Model Caliber Date Score

4. Weapon Make Model Caliber Date Score

ADDITIONAL CLASSIFICATIONS:

CPR FIRST AID

Date Date

DE-ESCALATION SAFE RESTRAINT Date Date

TRAINER INFORMATION:

1. PRINT TRAINER’S NAME SIGNATURE CERTIFICATION # E-MAIL TELEPHONE 2. PRINT TRAINER’S NAME SIGNATURE CERTIFICATION # E-MAIL TELEPHONE ASSISTANT TRAINER (PRINT NAME) SIGNATURE

Comments: FORM # IN-1144 (Rev 09/2022)

Donald Gregory 931079 *********@*****.*** 901-***-**** Perry, Michael R. 425 17 7788

2-25-2023 92

2-26-2023 76

Tauruis G2 9mm 2-25-202*-***

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