Alpha omega JIU-JITSU Waiver

AFTER YOU SUBMIT YOUR FORM, CHOOSE YOUR FREE TRIAL CLASS

Which services are you interested in now or in the future? (select all that apply)

Brazilian Jiu-Jitsu

Muay Thai

Mixed Martial Arts

Kickboxing/Boxing

Fitness Classes

Self-Defense Seminars

Nutrition Plans

Yoga

Karate

Zip Code

Is the student who is enrolling 18 or older?

Parent or Guardian's Full Name (as shown on ID)

Student's First Name (as shown on ID)

Student's Last Name (as shown on ID)

Student's Nick Name (optional)

Student's Date of Birth

Email Address

Phone Number

How did you hear about us?

Name of friend who referred you

Which social media site did you see us on?

Why do you want to join? (check all that apply)

To get/stay in shape

To learn self-defense

To compete in tournaments

To update my training for work

Just for fun

Other

Where do you work?

What is your current weight in lbs?

You selected "Other" for why you want to join, please explain:

Have you trained in any Martial Art before?

Which Martial Art have you practiced?

How long have you trained in this martial art?

If you are currently enrolled in other martial arts or fitness gyms, where are you currently enrolled

You selected "Other", which gyms are you a member of?

I accept terms & conditions in theINJURY AND LIABILITY WAIVER

I accept terms & conditions in theCOVID WAIVER

I accept terms & conditions in thePHOTO RELEASE

I declare that the info I’ve provided is accurate & complete

The following signature legally binds you to the agreements, terms, and conditions in this entire document.

Student's Signature

Parent or Guardian's Signature

Today's Date

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