Myriad Jiu Jitsu

Myriad Jiu Jitsu

This form must be submitted before classes can be attended.
Student full name*

First NameLast Name
Student Title*
Student Gender*
Student Date of Birth*

DayMonthYear
Date
For students under 16 only - Parent full name

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
example@example.com
Phone Number *
Emergency contact*

First NameLast Name
Relationship to student*
E-mail*
example@example.com
Phone Number*
General Health questionnaire

General Health Questionaire*

	Yes	No
Have you had any serious illness or injury in the past 5 years?
In the past month, have you had chest pain when you were not doing physical activity?
Have you ever lost consciousness or experienced dizziness during exercise?
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you have any musculoskeletal injuries (e.g. knee, shoulder, neck)?
Do you have a bone condition that may weaken your bones i.e. osteoporosis?
Have you ever suffered a concussion or traumatic brain injury?
Have you been hospitalised in the past 6 months with a medical emergency?
Have you had any surgeries or hospitalisations in the past 5 years?
Are you pregnant or recently postpartum?
Do you currently take any prescribed medication?
Do you suffer from any chronic condition (e.g., asthma, diabetes)?
Do you have high or low blood pressure?
Do you have any allergies (including to latex, nuts, or medications)?
Are you currently under the care of a physiotherapist or medical professional?
Do you consider yourself to be disabled?

If you answered yes to any of the questions above please explain in detail about the condition below.
Do you know of any other reason why you should not train BJJ or any other information you would like to share about your general health? If yes, please explain fully.
Do you require any adaptations or support in class? Please explain.
Please Note: If your health status changes in the future, leading you to answer YES to any of the above questions, please consult with your doctor before continuing physical activity and inform Myriad Jiu Jitsu.

If you are aware of any medical conditions which may affect your health when exercising, please speak to a doctor before participating.

Our instructors are first-aid trained. If you feel unwell whilst in our facilities, please speak to an instructor.

If you require further information, please speak to an instructor or contact us at info@myriadjiujitsu.com
I confirm that the above information is accurate to the best of my knowledge. I understand that Brazilian Jiu Jitsu is a physically demanding sport, and I accept responsibility for monitoring my own physical condition and informing the coaching staff of any changes. I will seek medical clearance if needed.
Initials*

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Liability Waiver
In consideration of being allowed to participate in any way in the sanctioned events of Myriad Jiu Jitsu, 329-331 Brockley Road, SE4 2QZ.

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, the regulations of participation, or the conditions of the premises, or of any of the equipment used.

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 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. I have been given a copy of the rules and regulations of Myriad Jiu Jitsu and agree to abide by the instructions given therein.

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 intense training practice and/or competition.

8. Grant permission in case of injury to have a doctor, nurse, athletic training or other emergency medical personnel provide me with medical assistance or treatment for such injury.

9. Release, waive, discharge and covenant not to sue, Myriad 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 lessors and lessees 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 releasees or otherwise.

I HAVE READ THE ABOVE WARNING, WAIVER, RELEASE AND AGREEMENT TO PARTICIPATE. I UNDERSTAND ITS CONTENTS AND DO HEREBY SIGN IT VOLUNTARILY
Initials*

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Bookings and Cancellation Policy
If you are/become a member:

We require our members to book in for every sessions they attend for insurance purposes. Bookings must be made through the MAAT app. If you do not book into class you will be denied admittance until your place has been booked. You will recieve reminders leading up to the booked session, giving you opportunity to cancel the session if required. If you find you can no longer attend the booked session please cancel as soon as possible. If you do not cancel your booking and there is a waitlist for the class you may incur a £5 penalty charge.
Initials*

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Billing policy
If I purchase a Myriad membership, I agree for Myriad Jiu Jitsu to bill me monthly for the membership selected. If I wish to cancel my membership at Myriad Jiu Jitsu, I agree to give 2 week's notice via email. I understand that cancelling directly at the bank does not adhere to this agreement with Myriad Jiu Jitsu and will result in the correct membership fees within this 1 month notice period being owed to Myriad Jiu Jitsu, which must be paid within 2 weeks of the date this was due.

If I cancel my Direct Debit from the bank accidentally I agree to pay the admin fee to re-activate my membership, understanding that this creates undue admin for the Myriad Staff.
Initials*

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Policies
Please find Myriad Jiu Jitsu's policies here:

Club Rules Privacy Policy Terms & conditions Code of Conduct

All other policies including our Safeguarding policy can be found here.

Please take the time to familiarise yourself with these documents.
Club Rules, Privacy Policy, Terms & Conditions and Code of Conduct*

I have read and agree to Myriad's Club Rules, Privacy Policy, Terms & Conditions and Code of Conduct
Contact consent*

I consent be contacted by Myriad Jiu Jitsu on matters pertaining to the club, my membership and any other relevant information.
Insurance*

I agree to pay £10 annual insurance whilst I am a member of Myriad Jiu Jitsu, which starts the day I sign up.
Signature
Signature*

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Myriad Jiu Jitsu

General Health questionnaire

Liability Waiver

Bookings and Cancellation Policy

Billing policy

Policies

Signature