CU Jiu Jitsu Intake Form

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This is an intake and liability waiver form and it is required to be completed in full before participating in any classes at CU Jiu Jitsu. All parts must be completed unless otherwise specified. This is NOT a financial agreement form. If you have questions, please contact us at mike.cubjj@gmail.com or use the contact form on the website at www.cu-bjj.com

Email *

Please provide your full legal name *

Please provide your gender *

Male

Female

Non-binary

Prefer not to say

Other:

Please provide your pronouns:

he/him

she/hers

they/them

Other:

Date of Birth *

YYYY

Current Mailing Address *

Preferred Phone Number *

Emergency Contact: Please list Name, Phone, and Relationship to you *

How did you hear about CU Jiu Jitsu? (We reward our members who refer new students. Make sure to provide their full name for them to receive credit for your sign-up)

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