Adaptive Judo Registration Form
Welcome! We are looking forward to having your child join the Fresno Judo Club Adaptive Judo Program!

Complete the form below to register. Please note the following:
  • Kiwanis Club of East Fresno is sponsoring the first 20 participants which includes Adaptive Judo Program dues, USJF membership, and a judo gi.
  • Parent/Guardians are welcome to participate on the mat to support their student.
  • Students should wear soft comfortable workout clothes that can be put over their judo gi (t-shirt, running shorts, yoga pants, etc.).
  • Judo gis (uniform) are available at the dojo. Instructors will help students find the right size.
  • Long hair must be pulled back and fingernails kept short.
  • Bring a water bottle.
  • Plan to fill out a paper USJF membership application at the dojo at your first practice.
Please feel free to contact Sensei Kris at 559-360-7155 if you have any questions.
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Email *
Student name *
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Date of Birth
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Student Age (6-13) *
Parent/Legal Guardian Name *
Primary Phone Number
Secondary Phone Number
Emergency Contact Name (Different from above)
Emergency Contact Phone Number (Different from above)
Address
Health Considerations
Other Special Considerations
Student interests/preferences
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Any sensory sensitivities? (i.e., noises, lights, smells)
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