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Registration Form

The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

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mitch sawyer
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183 views2 pages

Registration Form

The document is a registration form for the Louisiana Brazilian Jiu Jitsu Federation competitions. It requests information such as name, address, date of birth, team name, and contact details. It lists the different divisions and age/weight classes competitors can register for, including Brazilian Jiu Jitsu, No-Gi, and Xtreme Youth Martial Arts. It includes a liability waiver and outlines the registration pricing for members and non-members. Payment can be made via PayPal or check to the Gracie Barra Northshore organization.

Uploaded by

mitch sawyer
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Louisiana Brazilian Jiu Jitsu Federation www.LBJJF.com – info@lbjjf.

com

Registration Form for the Official LBJJF Competitions


Name: Mitchell Sawyer_____Address:_5614 Kade Daniel Dr _______________________________________________

City: Iowa__________________ State/Province: LA_____________________Zip Code: 70647___________

Home Phone:337-377-6050______________ Date of Birth: 4/13/81_____________ Team Name: LABJJ___________

E-mail: [email protected]___________________________________________________ Sex:_Male__________

BRAZILIAN JIU JITSU DIVISIONS: Mark (X) Absolute( open weight)


_______________BJJ Weight Classes: White Blue Purple Brown Black

4-6yrs 7-9 yrs 10- 12yrs 13-15yrs Adult Master

NO GI DIVISIONS: Mark (X) Absolute( open weight)


_______________NO GI Weight Classes: Beginner Intermediate Advance

4-6yrs 7-9 yrs 10- 12yrs 13-15yrs Adult Master

Xtreme Youth Martial Arts: Mark (X)


_______________Weight Classes: 7-9 yrs 10- 12yrs 13-15yrs 16-17 yrs

TOURNAMENT RELEASE AND WAIVER: I understand the rules of the tournament and will abide by them. I understand that I am participating in a
sport that has body contact and understand that injury can occur with my participation. I assume full responsibility for all of my actions during and
connected to the above tournament. I understand the risk of competing in this form of Martial Arts competition and hereby release the event organizers
and all of its employees and associates, tournament sponsors and the event facility, from any type of injury, loss, or death sustained while competing in this
competition. I also state that I am in good physical condition and know of no reason why I cannot participate in this event. I have current and valid health
insurance. I understand that The LBJJF LLC does not offer refunds and divisions or weight classes are subject to change. In case of an emergency, I hereby
authorize any licensed medical personnel to perform any accepted medical procedure deemed necessary and I agree to bear the expense of any such
treatment. I also agree that my attendance and/or performance at the tournament will be photographed, filmed, and/or taped and used exclusively by The
LBJJF LLC for promotional or commercial purposes and I waive any compensation thereof. I agree to not use ANY footage obtained at the event for
commercial purposes without expressed, written consent from The LBJJF LLC.. I have read the rules and release above and agree to all of its terms.
Signed: _______________________________ Print Name:___________________________________ Date: _________

PRICING:
Brazilian Jiu Jitsu /No Gi
Pre Registration (till one day before the event) $60

Registration (day of the event)


Member of LBJJF $60
Non Member of LBJJF $80

Xtreme Youth Martial Arts only : $60


If you are fighting XYMA + BJJ/NoGi additional $20 on the BJJ/No Gi registration

PO Box 2365 – Hammond, LA 70401– Phone: 985-605-3169 – Fax 985-520-0830


Paypal [email protected] or write a check to Gracie Barra Northshore
www.paypal.com
Louisiana Brazilian Jiu Jitsu Federation www.LBJJF.com – [email protected]

PO Box 2365 – Hammond, LA 70401– Phone: 985-605-3169 – Fax 985-520-0830


Paypal [email protected] or write a check to Gracie Barra Northshore
www.paypal.com

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