DZRSI Student Agreement

To Enroll in a DZRRT Program, you must be an AJJF member. If you are not,  first complete an AJJF Registration, which will include a Background Screen.  Then you can complete this form.

DZRSI Student Agreement
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Program Information (if known)

Personal Information

Address
Address
City
State/Province
Zip/Postal
Country

AJJF Information

(Jujitsu is not required to be accepted into a DZRRT program)
Are you studying jujitsu at an AJJF Dojo?

Since you answered yes to the above question, please also answer the next 3 questions that are related.

I Would you like to apply for a Professor Pat Browne DZRRT Scholarship?
I am unaffiliated with an AJJF School

Previous Training

If you graduated from a Danzan Ryu Restorative Therapy (DZRRT) Program

Section

I understand that to enter this course, I agree to

  • be an AJJF Registrant and maintain my Registration for the duration of the program and
  • I understand that the AJJF Registration fee is non-refundable
  • complete an AJJF background Screen and maintain a “Clear Status” for the duration of the program and I understand that the AJJF Background Screen fee is non-refundable
  • pay all Program fees
  • sign the DZRSI Ethics Statement.  This is different from the AJJF Black Belt Ethics Statement.
  • be at least 18 years of age of older
  • physically give and receive bodywork in the Program
  • have a High School diploma, or GED, or demonstrate an ability to benefit from the Program.
  • Before and during the Program I will inform the Program Director of any personal health concerns relevant to the giving and receiving of bodywork and that the information I share will be held confidential.

My signature physically or electronically affirms my agreement to all of the terms above. The information I have provided is accurate to the best of my knowledge.

I agree to the above terms.

Completion of this registration, including a non-refundable fee of $200 to the DZRSI, will allow you to enroll in a DZRRT program.