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YR Jiu Jitsu Team

6761 W Sunrise Blvd, Unit 18

Plantation, FL 33313

ACKNOWLEDGEMENT AND RELEASE FORM

 

I, the applicant, on behalf of myself, members of my family, my heirs, executors, administrators and assigns, hereby forever release, discharge and hold harmless Crave Fitness Inc, Team Crave, Yaniv Rosenberg or representatives and agents for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in Personal Training, Martial Art Classes, CrossFit classes, Fitness classes, Self Defense Seminars and activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Crave Fitness Inc, Yaniv Rosenberg, representatives or agents.  Please note:  Participants must supply their own protective equipment.

 

The undersigned acknowledges that:

He/She is desirous of using, as a member on a membership basis, the Martial Arts School herein referred to as “«Crave Fitness Inc»”.
He/She confirms that there were no verbal presentations other than those specified in this agreement.
He/She may be photographed or filmed while attending at the premises of «Crave Fitness inc» and he/she gives permission to «Crave Fitness Inc», and any affiliates to use any and all photos, video footage, and/or video streaming for promotional, sales, publicity, and advertising purposes for all media including internet.
The waiver was read and he/she agrees to abide by it.

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
A signed copy of this waiver will be sent to the email address you provide.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Have you trained in Martial Arts before?*
No
Yes

If yes, when was the last time?

Where?

For How long?

Current Rank?
How many days per week are you looking to train? *
1-2
3-4
5-6

What is your main goal in training?

Do you have any health conditions/injuries we need to be aware of?

How did you hear about us?
What program are you interested in?
Brazilian Jiu Jitsu
Kids Brazilian Jiu Jitsu
Krav Maga
Fitness
Private Lessons
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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