Sign up - Elemental Jiu Jitsu

Member Details

* Required field

Visitor Member

* First name

* Last name

Phone Number Add secondary Phone +

Secondary Phone

Email Address

Add secondary Email +

Secondary Email Address

Date of birth

* Parent/Guardian's name

Pick a check-in code (4 digits)

Address

Street address

City

Zip / Postal code

State

Country

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 or use camera Upload photo

Membership

Select
Adult Jiu Jitsu

Duration 1 month
Access 2 sessions / week
Cost $65.00 / month + $25.00 signup fee + 13% Tax
Select
Kids Jiu-Jitsu (Monday Class)

Duration 12 weeks
Access 1 days / week
Cost $150.00 / 12 weeks + $25.00 signup fee + 13% Tax
Select
Kids Jiu-Jitsu (Saturday Class)

Duration 12 weeks
Access 1 sessions / week
Cost $150.00 / 12 weeks + $25.00 signup fee + 13% Tax
Select
Women's Self Defence

Duration 12 weeks
Access 1 sessions / week
Cost $150.00 / 12 weeks + $25.00 signup fee + 13% Tax
Select
Youth Jiu Jitsu

Duration 12 weeks
Access 1 sessions / week
Cost $150.00 / 12 weeks + $25.00 signup fee + 13% Tax

Membership Documents

Waiver / liability release

To the best of my knowledge, I am in good physical condition and fully able to participate in this program. I am fully aware of the risks and hazards connected with the participation in Brazilian Jiu-Jitsu, Judo, Muay Thai Kickboxing, Karate, Hapkido, Bootcamp Training, Weightlifting, or Aerobics, including physical injury or even death, and herby elect to voluntarily participate in said event, knowing that the associated physical activity may be hazardous to me and my property. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OR LOSS, PROPERTY DAMAGE, OR PERSONAL INJURY, INCLUDING DEATH, that may be sustained by me, or loss or damage to property owned by me, as a result of participation in this course. I further certify that I am at least 18 years of age. If under 18, my parent/guardian is the below signed. I hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE, Integrative Health Inc. Elemental Jiu Jitsu, Jason McDonald, Susan Walker, their officers, servants, agents, and employees (hereinafter referred to as RELEASEES) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or related to any loss, damage, or injury, including death, that may be sustained by me, or to any property belonging to me, while participating in physical activity, or while on or upon the premises where the event is being conducted. It is my expressed intent that this release and hold harmless agreement shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased, and shall be deemed as a RELEASE, WAIVE, DISCHARGE, and CONVENTION TO SUE the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the Province of Ontario. In signing this release, I acknowledge and represent that I HAVE READ THE FOREGOING Waiver of Liability and Hold Harmless Agreement, UNDERSTAND IT AND SIGN IT VOLUNTARILY as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreements have been made; and I EXECUTE THIS RELEASE FOR FULL, ADEQUATE AND COMPLETE CONSIDERATION FULLY INTENDING TO BE BOUND BY SAME.

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

Credit Card All transactions are secure and encrypted

Payment will be provided later.

Signup