Ruislip BJJ Registration/Disclaimer Form
The enrolee is aware in making this agreement to participate in training / martial arts classes at Ruislip BJJ that the sport is physically demanding and potentially dangerous and / or fatal. With this knowledge the enrolee agrees to indemnify and hold harmless from all losses caused by accident or injury the Instructor(s), assistants, or any third parties who may be enrolees of the same class or seminar or who are students with the Instructor, in the event that the enrolee or the said third party is injured in any way during the performance and execution of techniques or instruction provided in these classes.  

This release shall also include any landlord or leaseholder of any training facility in which training is conducted. 

I also agree that the terms hereof shall serve as a release and assumption of risk for my heirs, executors and administrators, and for all members of my family, including any minors.  

The enrolee attests that he or she is in good physical condition and has no known or suspected medical conditions that would preclude vigorous physical activity.  

It is recommended that participants have a checkup by a physician before beginning any new physical regimen.  

As part of the consideration for participation, the enrolee acknowledges and assumes all these risks and wishes to enrol in this course of instruction.  
Sign in to Google to save your progress. Learn more
Are you filing in this form for yourself or on behalf of your child attending the kids class? *
Student Name *
Parent name (if under 16)
Date *
MM
/
DD
/
YYYY
Confirm you have read & formally agree to the above disclaimer text and that your proceeding answers are accurate & factual. *
Your email address *
Telephone number *
Student date of birth *
MM
/
DD
/
YYYY
Please confirm you have read our kids class information page (only applicable to parents of children attending the kids classes): https://ruislipbjj.com/kids-classes-information-page/ *
Do you (or child if answering as part of the kids class) have any medical conditions that you need to make us aware of? If so, please add details below. If you have no medical conditions, please enter 'no' below. *
If you (or child if answering as part of the kids class)  have a prior medical conditions, please confirm you have consulted with a medical professional/doctor, who have deemed it safe to attend our classes *
Please enter alternative emergency contact details: name, relation and telephone (this should be different to the above details) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms