ASJJ Competitor Membership Application

First Name *

Surname *

Title

Street Address *

Suburb *

State *

Postcode *

Phone *

Date of Birth *//

Gender *

Male
Female

Current weight Kg *

Email *

Occupation

Association and Grade

Association/School *

Name of Association/School *

Name of Head of School *

Principal discipline *

Martial art

Current Grade *

Dan Grade
Senior grade over 18 yrs
Under 18 yrs

Within the association/school selected. Minimum age 17-years

Grade level *

Within the association/school selected

Have you studied other martial arts *

Yes
No

Details of other martial arts

Martial art or style and grade achieved

Health and Exclusion Declaration

Are you prescribed drugs that may impair reaction time or judgement *

Yes
No

What type of drug or medication *

Have you suffered any incapacity requiring medical attention in the past 12 months? *

Yes
No

Provide details *

Have you any physical impairment, injury or medical condition that currently affects you *

Yes
No

Provide details *

Are you aware of any health problem you have that, in the interests of your safety, the health and safety of other members and or instructors/coaches, the Australian Society of Ju-Jitsuans should be advised of? *

Yes
No

Provide details *

Has a medical practitioner or any other person or entity or a martial arts club or organisation ever excluded you from participating in martial arts in the past, or any form of exercise? *

Yes
No

Provide details *

Authority for First Aid, Medical Treatment *

I authorise the coaches, instructor(s) and other officials to give first aid to me in the event of injury and to arrange for me to be transported to hospital for medical treatment.

Indemnity Declaration of Understanding *

Martial Art Is Dangerous

It has been explained to me and I understand that training, practicing, or participating in martial art is dangerous and that I must at all times abide by the rules of Australian Society of Ju-Jitsuans and any instruction provided to me by Australian Society of Ju-Jitsuans and those instructing me in Jujutsu and obtain clarification before proceeding if those rules or that instruction are not understood. Further I understand and agree that my participation is entirely at my own risk. I and any other person in relation to myself hereby absolves, indemnifies and holds harmless the providers, including others receiving instruction from all liability howsoever arising for injury, loss or damage (including but not limited to my person, property and personal belongings) however caused, including by the negligence of the indemnified, arising out of or in connection with the provision of instruction or related services or in any way caused by, or arising out of any activity carried on by the providers.

Sport Integrity Australia

All sports throughout Australia are obliged to commit to a policy on anti-doping in compliance with both Australian and World anti-doping authorities. The anti-doping policy of Sport Integrity Australia (previously managed by ASADA) sets down those obligations for everyone engaged in sport.

Anti-Doping Policy *

Acceptance of Anti-doping Policy

I have read, understood and agree to abide by the Australian National Anti-Doping Policy, effective 1 January 2021, being the anti-doping policy adopted by Australian Jujitsu Federation and Australian Society of Ju-Jitsuans, and applicable to all member, participants and non-participants. I have also read, understood and agree to abide by the associated policies as adopted by Australian Jujitsu Federation, and Australian Society of Ju-Jitsuans.

A copy of the policy is available on the website of Sport Integrity Australia.

It is important to have an anti-doping policy as it helps Australian Jujitsu Federation and Australian Society of Ju-Jitsuans, to provide a doping-free environment that promotes health, fairness and equality for all Australian Jujitsu Federation and Australian Society of Ju-Jitsuans, members. To help us achieve this goal, please make yourself aware of your rights and responsibilities under this policy by using the education resources provided by Sport Integrity Australia.

Date *//

Emergency Contacts Name *

Phone *

Relationship to Applicant *

Declaration *

I hereby certify and declare that all the information contained in the declarations above are true and accurate.

Guardian's Consent *

I hereby certify and declare that all the information contained in the declarations above are true and accurate and that I consent to the Applicant receiving instruction in and training, practicing and participating in, the martial arts and competition.

Required for all persons under 18 years of age

Signature *

Captcha *

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Membership Fee

Price: $ 25.00

This annual fee goes towards the membership paid by ASJJ to the WCJJO.

Payment method *

ASJJ bank account details for payment: Account name: Australian Society of Ju-Jitsuans Bank BSB: 484 799 Account number: 084525833 REFERENCE: insert the word Comp plus your name