New Membership

First Name *

Middle Initial

Last Name *

Surname

Address *

Address

City

State/Province

Zip/Postal

Country

Email Address *

Phone Number *

Phone Number Type

Mobile

Work

Home

Date of Birth *

Age *

Country of Citizenship *

Foreign Address Fee Applies

Registration Type *

Youth (age 16 or younger)
Adult (age 17+)

Instructor Name *

Club Name

Club Number

Which Art(s) Do You Have Rank In? *

Judo

Jujitsu

Both

Date Judo Rank Obtained

Choose Appropriate Judo Rank *

Choose Appropriate Jujitsu Rank *

Date Jujutsu Rank Obtained

In consideration of being allowed to participate in any way in the American Traditional Jujutsu Association martial arts program(s), and related events and activities, the undersigned:

Agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he or she shouldinspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he or she will immediately advise his or her coach or supervisor of such condition(s) and refuse to participate.
Acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury,including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inactions.

or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

Assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanentdisability or death.
Release, waive, discharge and covenant not to sue the American Traditional Jujutsu Association, its officers, its affiliatedclubs, their respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and lessees of premises used to conduct the event, all of which are hereinafter referred to as 'releasees' from any and all liability to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages 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 releasee or otherwise.

This is a Waiver and Release of Liability:

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REGISTRANT OR PARENT/GUARDIAN SIGNATURE HERE

Date *

Tax Deductible Donation

Total *

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