Juniors | Ages 6-13 Release Form

Enter the students name first and the parent or guardian in the emergency contact section. (No profile photo needed)

Must be 18 years or older to complete this form. If the participant is a minor, a parent or guardian must complete this form.

Personal Information

FIRST NAME *

LAST NAME *

UPLOAD PROFILE PHOTO

ADDRESS LINE 1

ADDRESS LINE 2

TOWN/CITY

POSTCODE

EMAIL ADDRESS (PRIMARY) *

EMAIL ADDRESS (SECONDARY)

GENDER

PHONE NUMBER

MOBILE NUMBER

DATE OF BIRTH

Emergency Contact Information

NAME

RELATIONSHIP

PHONE

MEDICAL / ALLERGY NOTES

You'll be joining:

MMA JUNIOR

You're enrolling at:

1836 BRUCE B DOWNS BLVD

Please read and sign the following agreements

Dojo Release

Juniors | Ages 6-13 Release Form

Personal Information

Emergency Contact Information

You'll be joining:

You're enrolling at:

Please read and sign the following agreements

Success!

Hmm...

Juniors | Ages 6-13 Release Form

Personal Information

Emergency Contact Information

You'll be joining:

You're enrolling at:

Please read and sign the following agreements

Which contact methods do you consent to?

Success!

Hmm...