Student Registration

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Child’s Name *

Child’s Date of Birth *

YYYY

Parent/caregiver’s Name *

Phone Number *

Emergency Contact (name and phone number) *

Any additional information regarding your child we should know that may impact their ability to participate in class (ie - underlying health conditions, such as asthma)

I recognize that the youth Jiu Jitsu program at times involves vigorous physical activity through various activities. I understand that participation in the kickboxing program involves certain risks and that regardless of the precautions taken by Next Move Jiu Jitsu and/or other participants, some injuries may occur. In order to properly protect my own safety and that of my fellow participants, I agree to follow the rules as well as others that may be given by my coaches. I certify that my present level of physical condition is consistent with the demands of active participation in the youth Jiu Jitsu program. I am confident that I fully understand, and appreciate the risks involved in active participation in this program. I, the parent of the above named registrant, give my approval for their participation in any and all of the activities that take place during class. I assume all risks of the activities and I do release, absolve and hold harmless, Next Move Jiu Jitsu, the coaches and/or any other approved instructors. In case of injury to my child, I hereby waive all claims against Next Move Jiu Jitsu and the coaches/instructors. I am voluntarily requesting permission for my child to participate. *

I am the participants legal guardian. I have read the above information and by checking this box agree to statements made above.

Required

We would like to use photos and videos of the youth Jiu Jitsu classes, and would love to share them on our Instagram account and Facebook page. Please complete the following section to let us know if we are permitted to use videos and/or photos of your child. *

I grant my permission to use photographs and/or videos of my child on the Next Move Jiu Jitsu Instagram account and/or Facebook page.

Please do not use any footage of my child on any social media platform.

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