Non-DZR Program Insurance Coverage Application

School Information

Name of the person completing this form
Co-School Head? *
Select Yes if there is more than one school head
School Mailing Address *
School Mailing Address
School Location Different Than Mailing Address? *
School Location *
School Location

Non-DZR Program Information

Questions? Contact gro.fjja@ecnarusni
Examples: aikido, iaido, tai chi, yoga. Complete a separate application for each non-DZR program.
Describe the non-DZR program instructor qualifications, affiliation with the AJJF and more about the style and skills to be practiced in the non-DZR program.

Declaration and Signature

I understand that all students and instructors attending AJJF Schools in the U.S. must hold current Individual AJJF Membership. To maintain my Member-School status, I agree that all participants at my classes & events will hold current AJJF Memberships, full term or temporary.

I agree to adhere to the rules and standards of the AJJF. I understand that only AJJF sanctioned classes and events are covered by the AJJF group insurance. I further agree to the following guidelines:

  • All work-outs and practices are supervised
  • Appropriate protective equipment is worn
  • No intentional full contact striking. Light tag contact is allowed.
  • No full contact sparring.
  • No tournaments of kickboxing or any tournaments for cash prizes.