Seminar Registration Form
IN CASE OF EMERGENCY PLEASE CONTACT
SEMINAR & BELT TESTING (belt tests are for Members only)
Please specify which seminar and day(s) attending:
FORM OF PAYMENT
(Foreign applicants must pay in U.S. dollars)
____ Check ____ Money Order ____ Visa ____ Mastercard ____
PARENT’S OR GUARDIAN’S ADDITIONAL INDEMNIFICATION
(must be completed for participants under the age of 18)
In consideration of___________________________________(print minor’s name) ("Minor") being
permitted by the Rickson Gracie International Jiu-Jitsu Association/ Samurai Enterprises, LLC to
participate in its activities, I further agree to indemnify and hold harmless Rickson Gracie International Jiu-Jitsu Association/ Samurai Enterprises, LLC from any and all claims which are brought by, or on behalf of Minor, ad which are in any way connected with such use or participation by Minor.
Parent or Guardian Signature _____________________________________
Print Name____________________________ Date ___________________
I understand that by entering this Seminar I will be training at my own risk and that the Rickson Gracie International Jiu-Jitsu Association/ Samurai Enterprises, LLC is not responsible or liable for injuries or demages sustained during this Seminar.
Signature______________________________ Date ___________________