Blue Dog Jiu-Jitsu Waiver/Registration Form

First Name

Last Name

Please complete before attending. This is not a contract and no money will be taken. Please contact us should you have any questions.

Select an Address

Email Address

Date of Birth

Phone

If under 18, name of parent or guardian

Emergency Contact Name

Emergency Contact Number

Any Previous Martial Arts Experience

Heath Declaration - Have you had any previous surgery? Do you have Asthma, Diabetes, or any other medical conditions that Blue Dog Jiu-Jitsu should be aware of?

I entirely upon my own initiative and risk and responsibility am about to participate in Brazilian Jiu-Jitsu, Submission Grappling and Mixed Martial Arts training at Blue Dog Jiu-Jitsu, Yeovil. I am at least 18 years of age. If I am under 18 years of age, a parent or guardian will sign below on my behalf. I understand that Brazilian Jiu-Jitsu, Submission Grappling and Mixed Martial Arts can cause serious injury or even death. I will be learning to immobilise an opponent using chokes and joint locks, this can cause unconsciousness and trauma to joints such as the shoulder, knee, or elbow. When training in Brazilian Jiu-Jitsu, Submission Grappling and Mixed Martial Arts, bumps, bruises, scrapes, scratches, and soreness are commonplace, and most students will encounter this sort of minor injury from time to time in their training. More serious injuries are possible, including sprains, strains, twists, cramps and injuries of similar magnitude and student can expect these injuries infrequently. The possibility of more serious injuries exists, including fractured bones and torn ligaments, though not all students encounter such serious injuries. Knowing all of the above, I freely choose to participate in class and acknowledge my risk. Therefore, I do hereby for myself, my heirs, executors, and administrators release and hold harmless Blue Dog Jiu-Jitsu, seminar instructors and any of the club instructors, from any and all liability, negligence, claims demands, actions or causes of actions, or caused of actions resulting from any participation in this sport/activity/class and associated activity. I hereby attest that I am in good general health to take part in physical activity and have not been advised against participating by a qualified medical professional. I certify that there are no health- related reasons or problems which preclude my participation in this activity. If I have any underlying health issues or worries, I will declare and discuss these with the instructor or club safeguarding lead prior to the commencement of the class. This disclosure is my responsibility.

I grant Blue Dog Jiu-Jitsu to photograph or record my likeness (or if under 18 the likeness of my child), and I authorise the use of these photographs or recordings for promotional or educational purposes. If I do not want my likeness (or the likeness of my child) recorded and used as outlined above I must inform a coach or instructor of Blue Dog Jiu-Jitsu prior to commencement of any class.

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