REGISTRATION

Location:
Impact Training Center
2751 E 9th Street, Suite B
Newberg, OR 97132

Date: Saturday, December 13, 2025
Start time: 10 am
Approximately 2 hrs.

ALL LEVELS WELCOME

AGES 16+ ONLY (If you are 16 or 17, this registration must be completed by your parent or a court ordered legal guardian.)

REGISTRATION DEADLINE DECEMBER 12, 2025

NO SAME DAY REGISTRATION AVAILABLE

Separate forms must be completed for each person attending.

GI REQUIRED

Registration Fee: $50 (nonrefundable)

Are you registering a minor child? (you must be a parent or court ordered legal guardian)*

YesNo

Name of Attendee*

First NameLast Name

Attendee Contact Number:*

Please enter a valid phone number.

Emergency Contact*

First NameLast Name

Emergency Contact Number*

Please enter a valid phone number.

Name of Academy Currently Attending*

Current Belt Level*

LIABILITY WAIVER

I certify and represent that I am 18 years of age or older.

I agree that all training and safety recommendations are undertaken at the sole risk of myself. Newberg BJJ, LLC dba Impact Training Center, owner, agents and employees (referred to as GYM) is not liable for any claims for injuries or damages to me or my property arising out of, or in connection with attending and participating in classes provided by GYM, or any actions taken within the facility outside of a coach’s supervision or without permission, whatsoever. I agree to indemnify and hold harmless GYM, its employees, subcontractors, and representatives from all claims of liability by me.

I agree to abide by any rules and regulations issued by GYM. Failure to do so may result in expulsion from training and the forfeiture of all monies paid to the GYM.

I give GYM the irrevocable right to use video or photograph in all forms of media, including composites for social media, advertising, publication, or any other lawful purposes, and waive any right to inspect or approve the finished product, including written copy created in connection with the image.

The Gym shall not be responsible for damaged, lost or stolen articles, inside or outside the facility.

I understand this is a waiver and release of liability and I voluntarily agree to its terms.

LIABILITY WAIVER FOR A MINOR

I certify and represent that I am the parent or legal guardian of the minor child(ren) listed on this form.

I agree that all training and safety recommendations given to my minor child(ren) listed are undertaken at the sole risk of myself. Newberg BJJ, LLC dba Impact Training Center, its owner, agents and employees (referred to as GYM) are not liable for any claims for injuries or damages, whatsoever, to my minor child(ren) listed or property arising out of, or in connection with attending and participating in classes provided by GYM, or any actions taken within the facility outside of a coach’s supervision or without permission. On behalf of my named minor child(ren), I agree to indemnify and hold harmless GYM from all claims of liability by me.

I agree my named minor child(ren) will abide by any rules and regulations issued by GYM. Failure to do so may result in expulsion from training and the forfeiture of all monies paid to the GYM.

I give GYM the irrevocable right to use video or photograph in all forms of media, including composites for social media, advertising, publication, or any other lawful purposes, and waive any right to inspect or approve the finished product, including written copy created in connection with the image. GYM will not publish the names of minor children with said images without my consent or that of another parent/legal guardian.

The Gym, owner, agents, and employees shall not be responsible for damaged, lost or stolen articles, inside or outside the facility.

I understand this is a waiver and release of liability and I voluntarily agree to its terms.

Date of Birth if Minor Child*

Date

Name of parent or legal guardian*

First NameLast Name

Signature*

Parent Mobile Number*

Please enter a valid phone number.

After submitting registration, you will be redirected to a secure payment platform to pay the nonrefundable $50 fee. REGISTRATION IS NOT COMPLETE UNTIL PAYMENT IS MADE.

KNEE CUT FUNDAMENTALS