Non-DZR Program Insurance Coverage Application School Information School Name * School Head Name * Name of the person completing this form School Head Email Address * School Head AJJF Rank * ShodanNidanSandanYodanGodanRokudanShichidanHachidanKudanJudanOther 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 * ShodanNidanSandanYodanGodanRokudanShichidanKudanJudanOther Second School Head AJJF Rank School Mailing Address * School Mailing Address School Mailing Address School Mailing Address City City State/Province State/Province Zip/Postal Zip/Postal School Location Different Than Mailing Address? * Yes No School Location * School Location School Location School Location City City State/Province State/Province Zip/Postal 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