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April 12th Crash Test Tommy Seminar

Complete the form below to reserve your spot!
Participant Name*

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Birth Date (ages 10+)*

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Parent or Legal Guardian

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E-mail (for club information and invoicing)*
Current or Previous Training Location(s)
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Do you have any medical history or conditions that could affect your ability to participate in contact sports? *

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Medical Conditions
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Seminar Payment

Spots are limited, payment is required to secure spot. Spots are transferable at least 24 hours before seminar, but not refundable. Refunds (minus service fees) for emergencies will be considered.

Please select 1 option below

Seminar Fee$40.00

This reserves your spot

Seminar Fee + $20 donation$60.00

This reserves your spot & donates $20 to CJJ scholarship program.

Seminar Fee + $50 donation$90.00

This reserves your spot & donates $50 to CJJ scholarship program.

Seminar Sponsorship Request$ Free

(Limited spots available, first come first serve) If you are unable to pay the seminar fee but would like to participate, please select this box and our board will review your request. Your spot is not guaranteed until you receive separate email confirmation from CJJ.

Other Payments$ Free

Please see Leah to process other payment amounts, and cash or check payments

Total $0.00

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Rules Acknowledgement*

I have read, understood, and accepted the rules for membership.
Privacy Policy
Photo Acknowledgement*

I understand that occasionally, photos and videos from competitions and practices will be used in promotional material and grant applications for CJJ. I agree to allow my image or my child's image to be used for this purpose and that I will not be compensated. I also understand that once a promotional item has been produced, it is not possible to remove my image or my child's image from the production.
Contact Acknowledgement*

I understand that CJJ will never share my contact information for commercial purposes. I may, however, be contacted by CJJ about gym announcements and information relevant to seminars, scholarships, or memberships.
Disclaimer and Waiver of Liability

Liability Waiver
1. Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe social and economic loss.
2. Recognize and understand that such risk may be due to not only my own actions, but also the action, inaction or negligence of others.
3. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.
4. Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate.
5. Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death.
6. Enter martial arts training and/or competition entirely of my own free will and understand the importance of following the rules of training and competition.
7. I certify that I am in good physical condition, and have no disease, injury or other condition that would impair my performance or physical and mental well-being during training practice and/or competition. If I have any injuries or illnesses that could affect my ability to participate, I will notify the club managers and coaches, and discuss the appropriateness of martial arts training with my or my child's doctor.
8. Grant permission in case of injury to have a doctor, nurse, athletic trainer or other emergency medical personnel provide me or my child with medical assistance or treatment for such injury. The cost of any treatment or hospitalization arising from injury during training or play shall not under any circumstance be paid by Canby Jiu Jitsu, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents.
9. Release, waive, discharge and covenant not to sue, Canby Jiu Jitsu, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations or their agents, and if applicable, owners and leasers of the premises from any and all liability to the undersigned, his or her heirs and next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the realeasees or otherwise.
10. Achnowledge that I may be removed from participating without refund if I do not act in proper manner according to common sense, the rules and ettiquette of the gym.
I have read, understood, and accept the disclaimer and liability waiver and sign it of my own free will
Signature of Member or Legal Guardian*

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April 12th Crash Test Tommy Seminar

Seminar Payment

Credit Card

Privacy Policy

Disclaimer and Waiver of Liability