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PRIVATE LESSON SIGN UP

Sign Up for Private Lessons

Complete the four steps below. After signing the waiver, you will choose a time for your free trial lesson.

1Contact
2Jiu Jitsu
3Waiver
4Free Trial

Leave this field empty

Step 1: Contact & Account Information

First nameLast namePhone numberEmail addressDate of birthProfile photo (optional)JPG, PNG, GIF, or WebP; maximum 5 MB.

Street addressApartment, suite, etc. (optional)

CityStateZIP code

Emergency contact nameEmergency contact phone

Are you currently serving in the military, a veteran, or a first responder?

Upload proof of serviceUpload a military ID, veteran ID, first responder ID, or other proof. JPG, PNG, WebP, or PDF; maximum 8 MB. This document is used only for academy verification.

Step 2: Student Information

The account holder from Step 1 is not automatically counted as a student. Tell us exactly who will receive private lessons.

How many people need private lessons? The Step 1 account holder is also Student 1. Copy their name and date of birth below.

Student 1

First nameLast nameDate of birth

How much Jiu Jitsu experience does this student have?What belt rank is this student?

Student 2

First nameLast nameDate of birth

How much Jiu Jitsu experience does this student have?What belt rank is this student?

Student 3

First nameLast nameDate of birth

How much Jiu Jitsu experience does this student have?What belt rank is this student?

Student 4

First nameLast nameDate of birth

How much Jiu Jitsu experience does this student have?What belt rank is this student?

Do the students have anything specific they want to work on?

Step 3: Waiver, Media Release & Digital Signature

Release of Liability and Assumption of Risk Agreement

NOTE: This form must be read and signed before the participant is allowed to take part in any activity.

IN CONSIDERATION of being permitted to participate in any way with CJ American Jiu Jitsu, I acknowledge and agree that:

The risk of injury from the activity involved is significant, including the potential for permanent disability and death, and while particular protective equipment and personal discipline will minimize this risk, the possibility of serious injury still exists.There is the chance of being injured as a result of my participation in the activities performed at CJ American Jiu Jitsu. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF OTHERS, and assume full responsibility for my participation.I understand that the activities are physically and mentally intense. I understand the rules set forth by CJ American Jiu Jitsu and that they exist for my safety and the safety of others. I will comply with all rules and regulations.I understand that in case of emergency, I hereby authorize any licensed medical personnel to perform any medical assistance deemed necessary and I agree to bear the expense of any such treatment.I may choose to cease any activity and vacate the property at any time during my participation, but will notify the present instructor prior to my cessation and departure.On behalf of myself, my heirs, assigns, personal representatives and next of kin, I HEREBY RELEASE CJ American Jiu Jitsu and all persons acting by, through or on behalf of CJ American Jiu Jitsu or otherwise involved in conducting the activities, which includes, but is not limited to, owners of the property, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH and loss or damage to person or property, WHETHER CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, except that which is the result of gross negligence and/or gross misconduct. I also agree to INDEMNIFY AND HOLD HARMLESS the Releasees from all claims, judgments and costs, including attorney’s fees, incurred in connection with any action brought as a result of my participation or observation of the activities.I understand and agree that this Release of Liability covers each and every activity and event in which I participate on this date and hereafter.I agree that my attendance and/or performance at the academy and at events associated with the academy may be photographed, filmed and/or taped and used by CJ American Jiu Jitsu for marketing purposes and I authorize the use of my image and I waive any compensation thereof – even if I discontinue my training at CJ American Jiu Jitsu.I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT. I FULLY UNDERSTAND ITS TERMS. I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

This waiver is to be enforced under the laws of the State of Missouri. Any claim filed against CJ American Jiu Jitsu must be filed in a court or jurisdiction in the State of Missouri.

Date: August 17, 2026

PARENT OR GUARDIAN OF PARTICIPANT UNDER 18 YEARS OF AGE MUST READ THIS FORM AND SIGN BELOW

This is to certify that I, as the parent/guardian, with legal responsibility for this participant, do consent and agree not only to his/her release of CJ American Jiu Jitsu, its members, and all other Releasees, but also I agree to release and indemnify and hold harmless the Releasees from any and all liabilities incident to said participant’s involvement in these programs on behalf of myself, my heirs, assigns and next of kin.

Parent / Legal Guardian

Complete this section if any participant is under 18 years of age.

Parent or guardian legal nameRelationship to participant

I am the parent or legal guardian of each minor participant listed, and I consent to their participation and agree to the parent/guardian release above.

Type your full legal name as your digital signatureDraw your signature

I intend my typed name and drawn signature above to serve as my legally binding electronic signature.

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