/APPLICATION TO TRAIN

One Jiu-Jitsu Application to Train + Liability Waiver

Full Name of the Participant

Age

Date of Birth

Let's Find Your Address

Your Phone Number

An Emergency Number

Have you trained in the Martial Arts before?

Yes

If Yes: What Discipline / How Long / Grade If Any

If you have any doubts about your physical ability to take part in any of our training programmes you are advised to consult with your GP before commencing training in order to gain permission to proceed.

IMPORTANT - Have you, or do you know of, any physical disability, current or past injury or any other medical condition/reason that may be injurious to yourself, or a danger to others, and that may restrict you or others, in any way, whilst training at One Jiu-Jitsu?

Yes

If Yes, please give full medical details below:

The One Jiu-Jitsu Confidential Medical Questionnaire

(All information given will be stored and saved for at least 5 years at a secure location away from the Dojo, in accordance with the Data Protection Act.)

1 - Do you have any physical conditions, including old injures, which may, however unlikely, result in further injury to yourself or others, whilst training? (E.g. Strains, Fractures, Dislocations)

Yes

2 - Do you have any medical conditions, which may, however unlikely result in injury to yourself or others, whilst training? (E.g. Asthma, Epilepsy)

Yes

3 - Are you currently taking any medication, or undergoing treatment by any form of healthcare practitioner? (E.g. GP, Osteopath, Chiropractor, Homeopath)

Yes

4 - Do you have any infective (skin, blood or other bodily fluid) conditions, which may be passed on to others, no matter how unlikely? (E.g. Hepatitis, HIV, Impetigo)

Yes

5 - Do you have any known allergies? (E.G. Penicillin, Elastoplasts)

Yes

If YES to any question above, please give further details below:

I understand that ALL Instructors & Students practice at their own risk. I unreservedly accept this as a condition of my training and agree that this fact has been fully explained to me before the commencement of any training, BJJ can be dangerous.I, the undersigned, do hereby voluntarily submit this my ‘Application to Train’ at One Jiu-Jitsu in order to participate in the Martial Arts. I am fully aware of the nature, inherent dangers, and risks involved in the activity. I do assume full and complete responsibility for any and all losses, damages, or injuries that I might sustain or incur, while attending, participating, or travelling to and from any events or sessions arranged by One Jiu-Jitsu, it’s clubs or affiliates. I hereby waive all claims against One Jiu-Jitsu, the Instructors, Assistants, Sponsors and any or all the Institutions or Organisations connected with or associated to One Jiu-Jitsu, for any or all injuries that I might sustain. By signing, I hereby certify that I fully understand what is written in this Release Statement and certify that I fully agree to the above Terms & Conditions herein stipulated.

I consent to the data provided to be used for the purposes of registration within the dojo and to provide emergency contact details for use when I am training (please tick if consent given);

For the purposes of keeping my records accurate and up to date, I agree to inform One JiuJitsu of any changes to the details provided.

One Jiu-Jitsu will process your information for registration purposes and keep it for the period of your training with us. It will be kept in a secure location, accessed only by those who require it and with the relevant clearances. Your data will not be shared with any other organisation or individual without your expressed consent. You have the right to transfer the data provided from the One Jiu-Jitsu to another institution. Upon cessation of training, or your own request, this form will be securely disposed of. You have the right to request a record of the data held on you at any time to determine its accuracy. You also have the right to withdraw your consent for us to process your data at any time. You also have the right to be forgotten and all your data to be erased / deleted. Upon such request, any personal information will be securely disposed of. Should such a request be received, training will not recommence until a new Application to Train Form has been completed.

Initials

Your Signature

Thanks for submitting your Application to train with us at

One Jiu-Jitsu. We will be in touch with you ASAP. Osss!

THIS IS YOUR FIRST STEP TO JOIN US!

LIABILITY WAIVER + Self Questionnaire:
Those who wish to participate in activities within and or organized by or through ONE JIU-JITSU must submit this application which shall be checked and approved prior to the commencement of any activity therein.

/APPLICATION TO TRAIN

One Jiu-Jitsu Application to Train + Liability Waiver

If you have any doubts about your physical ability to take part in any of our training programmes you are advised to consult with your GP before commencing training in order to gain permission to proceed.

The One Jiu-Jitsu Confidential Medical Questionnaire

(All information given will be stored and saved for at least 5 years at a secure location away from the Dojo, in accordance with the Data Protection Act.)

THIS IS YOUR FIRST STEP TO JOIN US!

LIABILITY WAIVER + Self Questionnaire:
Those who wish to participate in activities within and or organized by or through ONE JIU-JITSU must submit this application which shall be checked and approved prior to the commencement of any activity therein.

BRAZILIAN JIU-JITSU IN BRIGHTON, WORTHING, CHICHESTER & GUILDFORD

© Copyright 2015 Ivam Maciel. All rights reserved

/APPLICATION TO TRAIN

One Jiu-Jitsu Application to Train + Liability Waiver

If you have any doubts about your physical ability to take part in any of our training programmes you are advised to consult with your GP before commencing training in order to gain permission to proceed.

The One Jiu-Jitsu Confidential Medical Questionnaire

(All information given will be stored and saved for at least 5 years at a secure location away from the Dojo, in accordance with the Data Protection Act.)

THIS IS YOUR FIRST STEP TO JOIN US! LIABILITY WAIVER + Self Questionnaire: Those who wish to participate in activities within and or organized by or through ONE JIU-JITSU must submit this application which shall be checked and approved prior to the commencement of any activity therein.

THIS IS YOUR FIRST STEP TO JOIN US!

LIABILITY WAIVER + Self Questionnaire:
Those who wish to participate in activities within and or organized by or through ONE JIU-JITSU must submit this application which shall be checked and approved prior to the commencement of any activity therein.