L&T JJC Induction Form

Student Induction Form

To request membership/insurance with World Ju-Jitsu, Ireland as a Lurgan & Tandragee JuJitsu Club member
Start Date*

DayMonthYear
Number of participants*
Class frequency:

Contact Details
Address*

Street Address

Street Address Line 2

Town / CityState / Province

Postcode
Phone*
Mobile
Email Address*
example@gmail.com
Emergency Contact
Contact Name*
Emergency Contact Phone *
Relationship to participant*
I consent to photographs and / or filming for sporting purposes or PR under WJJF operations*

YesNo (If you do not consent please make your instructor aware of this)
Have you ever been convicted of a crime of violence?*

YesNo
If yes, please give details

DECLARATION
I agree to abide by all rules, notices and terms of membership and, at all times, uphold the traditions and spirit of Martial Arts. It is accepted and understood that participation in the Martial Arts carries the risk of injury, as in all contact sports. I understand that the WJJF Logo, its trademarks and its designs can only be used with the prior written consent of that organisation. I declare I am fit to train in the Martial Arts.
Signed*

Clear
Finally, how did you hear about us?
Calculation
Membership Summary*
prevnext( X )
Monthly membershipMonthly membership for all participants included in submission.
GBP for each month

Total

£0.00
Should be Empty:

Medical Information