Common Ground BJJ Adult New Student Application
Student's Name
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First Name
Last Name
Student's Age
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Date of Birth
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Gender
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Occupation
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Phone Number
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Format: (000) 000-0000.
Email Address
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Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Marital Status:
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Single
In a Relationship
Married
Divorced or Separated
Other
Do you have kids?
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Yes
No
How did you hear about us?
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Walked or drove by
Google
Yelp
Ecological Grappling Network
Referral
Other
Who were you referred by?
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Previous Experience
Have you ever done Brazilian Jiu Jitsu (BJJ) before?
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No, I am a complete beginner
Yes, I have previous BJJ training experience
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Previous Experience
Student has previous experience
How long have you trained for?
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What is your rank?
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White Belt
Blue Belt
Purple Belt
Brown Belt
Black Belt
What school(s) have you been a student at before?
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Are you currently a member at another school?
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Yes, I currently have a membership at another BJJ school
No, I do not have a membership at another BJJ school
Other
Where do you currently have a membership?
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How come you are looking for a new BJJ school?
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Are you coming back from a break in training?
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Yes, I am coming back from a break of 1 month or more
No, I am not coming back from a break in training
How come you took a break from training, and for how long? What has changed that you're ready to resume now?
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Have you competed in BJJ?
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Yes, I have competed before
No, I have not competed
Please describe your previous competition experience:
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Are you interested in competing in the future?
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Yes, competing is very important to me
No, it's not for me
Maybe / I am not sure
Have you ever been an instructor at a BJJ school?
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Yes, I have taught as an instructor at a previous school
No, I have never been an instructor at a BJJ school
Please describe your previous experience as an instructor:
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What is it specifically about Common Ground that makes you want to train here with us?
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Previous Experience
Student is a complete beginner
What is the main reason you are interested in learning BJJ?
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How come you are motivated to get started now?
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Have you done any trial classes at other schools? If so, please describe:
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What is it specifically about Common Ground that makes you want to train here with us?
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Other Martial Arts or Athletic Experience
Do you have any experience with other grappling martial arts (wrestling, Judo, Sambo, etc.)? If so, please describe:
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Do you have any experience with striking martial arts (boxing, kickboxing, Karate, Tae Kwon Do, etc.)? If so, please describe:
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Do you have any other athletic experience (high school or college-level athletics, recreational sports, run marathons, take workout classes, etc.)? If so, please describe:
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Selection of Interest
Which program(s) are you interested in? Select all that apply:
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Beginner Blueprint Private Lessons
Jiu Jitsu Group Classes
MMA Program
I'm interested in something else
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Availability
The Beginner Blueprint is a program of eight (8) half-hour private lessons. Please describe your availability for private lesson appointments:
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To participate in Jiu Jitsu group classes, all students must attend at least one session of Gi Fundamentals each week. Please select which class time(s) work for you on a regular basis:
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Wednesdays at 12:00pm
Wednesdays at 6:00pm
Saturdays at 12:00pm
The MMA Program is an advanced course. To participate in this program, students must also be enrolled in the Gi Fundamentals and No-gi Fundamentals courses and therefore attend a minimum of 3 class sessions per week.
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Yes, I am able to fulfill these requirements
No, I am unable to fulfill these requirements
MMA class meets on Tuesdays at 7:00-7:45pm. Does this class time work for you?
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Yes, this class time works for me on a regular basis
No, I can rarely or never make this class time
Sometimes
Please describe the service(s) that you are interested in:
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Questions or Concerns
Do you have any previous injuries, surgeries, or health conditions that are important for us to know about? If so, please describe here:
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Do you have any questions or concerns? If so, please describe here:
We offer a complimentary phone consult for new students. Would you like to speak to our manager for more information?
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No, a phone consult will not be necessary
Yes, I would like to request a phone consult
When is a good time for us to reach you?
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Submit
Should be Empty: