NQJJA Registration Form

North Queensland Ju-Jitsu Academy Inc Registration Form
Student Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState

Post Code
Birth date*

DayMonthYear
MaleFemaleOther
Parent/Guardian Information (if student/participant is under 18)
Name

First NameLast Name
Mobile Number

eg 0123 000 000Phone Number
E-mail
example@example.com
Alternative Emergency Contact
Emergency Contact's Name

First NameLast Name
Mobile Number*

eg 0123 000 000Phone Number
Does the student/participant have asthma, allergies, or any other medical condition? If yes, please describe.
Training Programs

For further information about our Training Programs, please visit our Website - North Queensland Ju-Jitsu Academy Inc
GROUP-1: Thursday Evenings, (4 Sessions), from Thursday 6th February to Thursday 27th February 2025Group-2: Thursday Evenings, (4 Sessions), from Thursday 6th March to Thursday 27th March 2025
Little Samurai - 5 to 9 Years Mondays & Wednesdays from 5:30pm to 6:00pmSub-Junior - 9 to 13 Years, Mondays & Wednesdays from 6:00pm to 6:45pmJunior - 13 to 18 Years, Mondays & Wednesdays from 7:00pm to 8:15pmAdults - 18 Years & up, Mondays & Wednesdays from 7:00pm to 8:15pm
Acknowledgement

I understand that all sports carry a risk of injury and that North Queensland Ju-Jitsu Academy Inc is not responsible for injuries or loss suffered as the result of participating in these activities.

From time to time North Queensland Ju-Jitsu Academy Inc will post photographs of our students, participants, coaches, and supporters online. I will let North Queensland Ju-Jitsu Academy Inc know by email if I do not consent to my or my child’s photos being shared.
Medical Authorisation

In the event of an injury or medical emergency, I allow North Queensland Ju-Jitsu Academy Inc to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the student named above.

I understand that all reasonable efforts will be made to contact the athlete’s parent and/or emergency contact if an injury or medical emergency occurs.
Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
Date

MonthDayYear
Date
Should be Empty:

North Queensland Ju-Jitsu Academy Inc Registration Form

Training Programs