Kids Brazilian Jiu Jitsu

Personal Information:

Name:  {name}

DOB:  {dob}

Address:  {address}

Phone:  {phone}

Emergency Contact:  {contact_name}

Emergency Phone:  {contact_phone}

Relationship to contact:  {contact_relation}

Liability Waiver:

I, the undersigned, being aware of my own health and physical condition, and having knowledge that my participation in any exercise program may be injurious to my health, am voluntarily participating in a physical activity.

Having such knowledge, I hereby acknowledge this releases any representatives, agents, and successors from liability for accidental injury or illness which I may incur as a result of participating in the said physical activity. I hereby assume all risks connected therewith and consent to participate in said program.

I agree to disclose any limitations, disabilities, ailments, or impairments which may affect my ability to participate in said martial arts and fitness program.