Jungle bjj medical form, Waiver, and emergency contact details

To register to our academy please fill out the following medical form

You are filling out this form on behalf of:

Yourself (Adult)

Your child

First Name

Last Name

Parent / Guardian Name

Email Address

Participant's Date of Birth

Emergency contact

Emergency Contact Phone #

Do you (or your child) have any restrictions on participating in intense physical activities?

Yes

Do you have any medical conditions we should be aware of?

I accept the responsibility to ensure that I am medically and physically fit before starting the training at Jungle BJJ Dublin

I understand and accept that the sports and combat disciplines practiced at Jungle BJJ Dublin involve unusual demands on human physique which makes participation in the disciplines potentially hazardous, and accordingly I agree that I am aware of the risks and accept them and will personally bear all conequences of any injury I / my child may sustain as a result of participation in the disciplines at Jungle BJJ Dublin. I hereby expressely release Jungle BJJ Dublin, its directors, employees, vonulteers, other clients, and agents from any actions, claims, liabilities, losses, costs or expenses arising from such injuries.

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

Initials

Today's Date

Your Signature

I agree for this data to be processed in line with Jungle BJJ Dublin's Privacy PolicyView Privacy Policy

Thanks for submitting!