Registration form

Three Points Brazilian Jiu Jitsu Registration Form

Name:_____________________________________________________________________________
Date of birth:________________________________________________________________________
Address:____________________________________________________________________________
___________________________________________________________________________________
Phone:______________________________________________________________________________
Email:_______________________________________________________________________________

Why are you interested in doing jiu jitsu? Exercise, self-defense, sport/competition, other? _____________________________________________________________________________________
Do you have prior jiu jitsu or grappling experience?
_____________________________________________________________________________________

Name of emergency contact:________________________ Relation:____________________
Phone number of emergency contact:______________________________________________________

Do you give consent for Three Points BJJ to include photos of you or your participating child on associated social media accounts and/or website?
Circle one: yes or no
Signature:_____________________________________________________________________________
Date:_________________________________________________________________________________