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WAIVER

Clobber Jiu Jitsu Waiver

First Name

Last Name

Email

Date of Birth

Are you physically capable to participate in Brazilian Jiu Jitsu?

No

Yes

Please specify if you have any physical limitations that we should know about.

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program.

Thanks for submitting!

clobber@clobberjiujitsu.com

(518) 801-3677

333 Delaware Ave Suite 4

Delmar, NY 12054

©2022 by Clobber Jiu Jitsu

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