Sign up - Liberty Jiu Jitsu

Member Details

* Required field

* First name

* Last name

Gender

* Phone Number Add secondary Phone +

Secondary Phone

* Email Address Add secondary Email +

Secondary Email Address

Date of birth

Pick a check-in code (4 digits)

Address

Street address

City

Zip / Postal code

State

Country

Emergency Contacts

Contact Name

Phone Number

Relation

Additional Contact

Photo

Edit Photo

Drag to reposition photo

Zoom

Rotate

Delete Photo Apply

Capture from camera No camera found. Please connect a camera to use this feature. Upload photo

Membership

Select
1 Day Trial

Duration Ongoing
Access Unlimited
Cost FREE

Start date:

Membership Documents

Waiver / liability release

I, {name} , have enrolled myself, or my dependant in the personalized health and fitness program offered through Liberty Jiu Jitsu LLC. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities including combat sports. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by Liberty Jiu Jitsu LLC.”

“In consideration of my participation in this program, I, {name} , hereby release Liberty Jiu Jitsu LLC and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment.” “I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I, {name}, hereby release Liberty Jiu Jitsu LLC and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death.”

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.

(Participant Signature)

{sign_date} (Date)

Done Clear Sign Below:

Signature

How did you hear about us?

Who referred the member to us?

More details:

Account Password

Please pick a password to log-in to your account later.

Password (minimum 8 characters)

Confirm Password

Payment

Select membership first

Payment Method
Pay Later

Name on card

Card Number

Expiration Date

CVV / CVC