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BJJ Skills Camp – Emergency Contact & Medical Form

Student Information

First name(Required)

Last name(Required)

Birthday(Required)

Year

Month

Day

Gender(Required)

Male

Female

Other

Camp Dates Attending(Required)

Mon

Tues

Wed

Thurs

Fri

How long has your child been training Jiu Jitsu? (Required)

What Academy does your child attend?(Required)

Goal for your Child

Please list what goals your child has, and what they're looking to get out of attending the Skills camp. ( Competing in Pans, get more experience etc)

Medical Information

Any known Medical Conditions (Asthma, Seizures?)(Required)

Any Medication Required? If so, Please list name of medication, and dosage.

If Yes, Will it be administered by:

Staff

Self (With Supervision)

Any Food Allergies or Food Restrictions(Required)

Emergency Contact Form

Primary Contact Name(Required)

Relationship to Child(Required)

Phone(Required)

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