Today's Date*

Kids first name*

Kids last name*

Parent/Guardian first name*

Parent/Guardian last name*

Email*

Phone number*

Street address*

Suburb/Town*

State*

Postcode*

Kids date of birth*

Any medical problems we should know about?*

Any allergies?*

Any special care needed?*

Choose the most important benefit you expect for your kids through the Jiu Jitsu.*

ExerciseDisciplineSelf DefenceWork with other kidsRespectSelf ConfidenceConcentrationCoordination/BalanceFocusFunCompetition

I hereby acknowledge and understand that Brazilian Jiu Jitsu is a physical activity and learning self-defence skills involves some physical contact. SJJA Hurstville, and or its staff and student are not to be held liable or responsible for any risks and/ or injuries as a result of training Brazilian Jiu Jitsu.*

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