Blue Dog Jiu-Jitsu Registration Form

First Name

Select an Address

Email Address

If under 18, name of parent or guardian

Last Name

Date of Birth

Phone

Emergency Contact Name

Emergency Contact Number

Any Previous Martial Arts Experience

Heath Declaration - Do you have Asthma, Diabetes, or any other medical conditions that Blue Dog Jiu-Jitsu should be aware of?

Photography Consent and Release

I understand and agree that participation in Martial Arts (Jiu-Jitsu) carry a risk of injury and that Blue Dog Jiu-Jitsu is not responsible for injuries or loss suffered as a result of participating in these activities. In the event of an injury or medical emergency, I allow Blue Dog Jiu-Jitsu to provide first aid, arrange transport to a medical facility, and authorise emergency treatment as recommended by a doctor for the member/ student named above. I understand that all reasonable efforts will be made to contact the member's /student's parent and/or emergency contact if an injury or medical emergency occurs.

Signature - Please Type:

Today's Date

Membership Options - Please select your preferred membership options. You can change this at any point, subject to availability.

Drop In - £10 per session

Lil' Pups (ages 5-9) - £40 per month (up to 2 sessions per week)

Junior & Teens (ages 10-14) - £50 per month (up to 2 sessions per week)

Adult - Any x4 Gi /No Gi or MMA, plus Open Mats - £70 per month

Adult - Any x2 Gi / No Gi or MMA, plus Open Mat -£60 per month

Adult - All Gi / No Gi and MMA, plus Open Mats -£99 per month

BEGINNERS 8 WEEK COURSE £60

Private Lessons (on request) - £40 per hour

Free Week / Unsure / Request special offer for more than one member per family

Preferred Payment Options - Please select one of the following:

Cash

Standing Order - You can instruct your bank (either by using your banking app or by visiting your branch) to set up monthly payments. Details will follow by email, after you have submitted this form.

Additional Information

Thanks for submitting your Registration Form! You will receive a confirmation email shortly.

CONTACT ME

ANY QUESTIONS?

TEL: 07864574639

Want to try a FREE SESSION? Send me a message or give me a call and we'll book you in.

Thanks for submitting!

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