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 *

If you are not already a member of ASJJ (grading with ASJJ), then please select 'Member of another Association/School

Name of Association/School *

Name of Head of School *

Principal discipline *

Martial art *

Current Grade *

Dan Grade over 18 yrs
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

Competition areas of interest *

Sport Jujitsu
Jiu-jitsu Ne-waza (BJJ)
Jujitsu Demonstration

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 including a commonwealth or state government body or a martial arts club or organisation ever excluded you from participating in competition; or martial arts; or 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 *

I confirm my agreement to the Liability Waiver

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.

I understand that while training or at an event or related activities, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the Australian Jujitsu Federation, producers, sponsors, organizers, and assigns.

ASJJ Code of Behaviour *

I confirm my agreement to the ASJJ Code of Behaviour

I agree to:
1. Operate within the rules and spirit of the sport of Jujitsu and Ne-waza (BJJ) and other forms of competition as set down by or agreed to by the Australian Society of Ju-Jitsuans (ASJJ).

2. Respect the rights and worth of every person regardless of their gender, ability, ethnic origin, or religion.

3. Within the scope of my role Official/Administrator or Competitor - Provide a safe and healthy environment for competition, ensuring that equipment and facilities are appropriate and meet safety requirements, placing the safety and welfare of the competitors above all else. In the event of injury, show concern and caution towards a sick or injured player and encourage players to seek medical advice when required. Allow further participation only when appropriate.

4. Act with integrity and be consistent and impartial when making decisions and not to allow prejudice, conflict of interest, or bias, to affect my objectivity, accepting responsibility for my decisions and actions.

5. Encourage and support opportunities for people to learn appropriate behaviours and skills, addressing unsporting behaviour and promoting respect for all people.

6. Act honestly, in good faith and in the best interests of the sport, displaying control and courtesy to all involved with the sport.

7. Conduct my responsibilities with due care, competence and diligence and respect the judgement and decisions of officials, coaches, and administrators in the conduct of the sport.

8. Ensure that any information acquired, or advantage gained from my involvement is not used improperly.

9. Support the Australian Society of Ju-Jitsuans and not to act in a manner that may be prejudicial to the Australian Society of Ju-Jitsuans, its objectives, or the rules and codes of conduct governing membership and or participation in competition, or in a manner that could bring the ASJJ, into disrepute.

10. Ensure that any physical contact is appropriate to the situation. Wherever practical, avoid unaccompanied and unobserved one-on-one activity (when in a supervisory capacity or where a power imbalance will exist) with persons under the age of 18 years.

11. Comply with the Member Protection Policy of the ASJJ and refrain from any form of harassment towards others this includes sexual, and racial harassment, racial vilification, and harassment on the grounds of disability. I understand I should not only refrain from initiating a sexual relationship with a student and/or competitor and/or official, but should also discourage any attempt to initiate a sexual relationship with me, explaining the ethical basis of my refusal.

12. Adopt responsible behaviour in relation to alcohol and other drugs and educate participants on drugs in sport issues in line with the Anti-doping Policy of the AJF.

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 *

I confirm my acceptance of the 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.

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 *

Date *//

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