Health Declaration

Please fill out the following form
in order to participate in our activity.

First Name

Last Name

Date of Birth

Phone

Address

Emergency Contact Name

Emergency Contact number

Have you been hospitalized in the last 12 months?

Yes

Are you suffering from a medical condition, illness, or injury?

Yes

If you answered yes to any question, please elaborate

Initials

Liability Release: Martial arts, combat sports, strength and fitness training are potentially dangerous activities. Before beginning any training or exercise program, you should first consult your physician. Bumps, bruises, scrapes scratches and soreness are commonplace, and most students will encounter this sort of minor injury from time to time in their training. More serious injuries are possible, including sprains, strains, twists, cramps and injuries of similar magnitude and students can expect to encounter these injuries infrequently. The possibility of more serious injury exists, including fractured bones and torn ligaments, though not all students encounter such serious injuries. As with any physical activity, there also exists the remote possibility of crippling or death. You are affirming that you understand the above statement of risk, and accept the responsibility for any training techniques, advice and/or methodologies mentioned herein. You assume responsibility for your own safety, understanding and accepting all risks involved with martial arts training. By assuming this risk, you completely absolve all authors, creators and affiliates of this club from liability for any injury, death or misuse of the information contained herein

Thanks for submitting!

Health Declaration

info@playfairjiujitsu.co.uk

64A Newhaven Road,
Edinburgh EH6 5TF