Application form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Application form

STUDENT ENROLMENT FORM

Email *

Name *

First and last name

Name of Parent or Guardian if under 18

I am enrolling in: *

Family Class (4yrs+)

Juniors (8-12 years)

Colts (13-17 years)

Seniors (18+ years)

Private Tuition

Mentoring

Protect-Her

Beginners Class

Other:

Date of Birth *

YYYY

I'm enrolling for? *

Foxton

Whanganui

Phone number *

Occupation

Employer

Photo ID Number (passport/license) Senior Students Only

Emergency Contact *

Emergency Contacts Phone Number *

Do you currently have any health ailments that may impact your training? *

YES

Required

If so please state (e.g. heart disease/ epilepsy/ arthritis/ stroke/ allergies/ etc)

Have you previously had any health ailments that may impact your training? *

YES

Required

If so please state (e.g. operations/ bone fractures/ head injuries/ etc)

Have you had any previous training or experience in Martial Arts? *

Yes

Required

If so please state Style, Instructor and Grade attained.

Is there any other information we should know which may impact the acceptance of your application? *

I wish to enrol for? (please tick one or more) *

TERM 1

TERM 2

TERM 3

TERM 4

Required

Rules of Acceptance I hereby apply for membership in the New Zealand Jiu Jitsu Academy and upon acceptance I agree to be bound by the following dojo rules and regulations established for maintaining order and protecting members from injury and to respect the discipline of the chief instructor and other instructors of the New Zealand Jiu Jitsu Academy. I will at all times maintain loyalty to and respect for the chief instructor and all other instructors of the New Zealand Jiu Jitsu Academy and affiliated organisations. I will not teach outside the New Zealand Jiu Jitsu Academy skills learned at the academy without the written permission of the Director of the New Zealand Jiu Jitsu Academy. I will maintain a high standard of conduct and will not take part in any activities which may discredit the New Zealand Jiu Jitsu Academy. I will not give public displays or performance of skills learned at the New Zealand Jiu Jitsu Academy without the written permission of the Director.While my membership of the New Zealand Jiu Jitsu Academy is current, I will not become or remain a member of another martial arts academy without the written permission of my Director. Any member who commits an act which could have resulted in the Academy obtaining a bad name is liable to immediate expulsion.I hereby declare that I have no undisclosed criminal records or convictions which could jeopardise my enrolment to become a member of the New Zealand Jiu Jitsu Academy.Member’s term fees must be paid within the week of the start of the new term or upon application or a 20% penalty will apply.At no time will the use of photos or film be used during training or in the media and social networking sites without the written permission of the Director. I agree to abide by the rules of the New Zealand Jiu Jitsu Academy. Students wishing to discontinue their training must give two weeks notice before the start of a new term or will be charged in full for said term. *

I have read and agree to the terms and conditions of the NZJJACADEMY

Required

Release and Indemnity Statement As a condition precedent of the acceptance of my application for membership to the New Zealand Jiu Jitsu Academy:I hereby agree to be legally bound, for myself, my heirs, executors and administrators, waive and release any and all rights to damages and claims I have against the said Association, its governing body, officials and members, for injuries or rights to damages suffered by me, directly or indirectly, as a result a result of attending in the course of instruction, training, competitions, exhibitions, or otherwise in the activity of jiu jitsu against the owners, organisations or members of the dojo, school, or place where held. I further certify that I am in proper health and physical condition to participate in such an activity. I also waive any and all rights to compensation, in any form for pictures, films, or video tapes taken of me in any above activity and grant permission for them to be used for any publicity or publication purposes. I hereby agree to pay within seven (7) days, my subscription for tuition and annual Membership Fee as determined by the Academy, and waive any rights of refund. *

I have read and agree to the Release and Indemnity conditions

Required

Thank you for your time.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of New Zealand Jiu Jitsu Academy. Report Abuse

Forms