INTRO FORM

GRACIE BARRA LONG BEACH

INTRO LESSON FORM
Student's Name*
Parent's Name
Date of Birth*

MonthDayYear
Date
Phone #1*
Phone #2
Address*
City*
State*
ZIP Code*
E-mail*
example@example.com
Current Occupation
Previous Martial Art Experience: *

YESNO
Do you do any other exercise?
How did you hear about the Gracie Barra Long Beach?
Who else do you know that trains at Gracie Barra Long Beach?
GENERAL RELEASE: I hereby acknowledge and understand that Brazilian Jiu-Jitsu is a physical activity and learning self-defense skills involves physical contact. Gracie Barra LBC LLC dba: Gracie Barra Long Beach and or its staff and students are not to be held liable or responsible for any risks and/or injuries or death as a result of training in Brazilian Jiu-Jitsu the undersigned participating in training at the above referenced facility, I for myself, my heirs, personal representative or assigns, dohereby release, waive, discharge, and covenant not to sue Gracie Barra LBC LLC, it's directors, officers, employees, students and agents from liability from any and all potential claims related to or resulting in personal injury or illnesses (including death) and property loss arising from any COVID-19 transmission that results from the undersigned being present at the facility and participating in training.
Student's Signature:

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Date:

MonthDayYear
Date
Parent or Legal guardian Signature:

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Date:

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Date
Should be Empty: