Non-DZR Program Insurance Coverage Application - The American Judo and Jujitsu Federation

School Information

School Name *

School Head Name *

Name of the person completing this form

School Head Email Address *

School Head AJJF Rank * School Head AJJF Rank

Co-School Head? *

Yes

No

Select Yes if there is more than one school head

Second School Head Name *

Second School Head Email Address *

Second School Head AJJF Rank * Second School Head AJJF Rank

School Mailing Address *

School Mailing Address

City

State/Province

Zip/Postal

School Location Different Than Mailing Address? *

Yes

No

School Location *

School Location

City

State/Province

Zip/Postal

Non-DZR Program Information

Questions? Contact gro.fjja@ecnarusni

Style *

Examples: aikido, iaido, tai chi, yoga. Complete a separate application for each non-DZR program.

Instructor Name(s) and AJJF Rank *

Estimated Number of Participants *

Class Schedule *

Program Description *

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.

Signature

Clear