East Orange

A beginner-friendly teens class focused on stand-up striking fundamentals, including boxing, kickboxing, and core technique work. This class helps teens build confidence, coordination, fitness, and strong fundamentals in a supportive, structured environment.

Martial Arts




JOSH KEY BRAZILIAN JIU-JITSU

Medical Questionnaire • Liability Waiver • Property Disclaimer • Media Release

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MEDICAL QUESTIONNAIRE

Due to the physical nature of Brazilian Jiu-Jitsu, please answer the following questions accurately. If you have concerns about your health, consult your physician before participating.

Please circle YES or NO:

1. Have you ever been advised by a doctor to avoid exercise? YES / NO  
2. Do you smoke? YES / NO  
3. Do you ever have difficulty breathing? YES / NO  
4. Have you ever had heart or lung problems? YES / NO  
5. Do you have asthma? YES / NO  
6. Do you have high blood pressure? YES / NO  
7. Do you have arthritis requiring medication? If yes, where?   
8. Are you diabetic? YES / NO  
9. Do you have past injuries that may recur? YES / NO  
10. Any major/minor surgeries in the past year? If yes, list limitations:   
11. Do you have osteopenia or osteoporosis? If yes, which and where?   
12. Are you pregnant? If yes, how many weeks?   
13. Have you been diagnosed/treated for contagious conditions (Staph, Herpes, etc.)?  
 If yes, list and include last treatment: _

If you answered YES to any question, notify your instructor before training.

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ASSUMPTION OF RISK & RELEASE OF LIABILITY

By participating in any class, training session, open mat, seminar, or activity at Josh Key Brazilian Jiu-Jitsu, the student acknowledges:

- Brazilian Jiu-Jitsu is a full-contact martial art.  
- Training includes joint locks, chokes, takedowns, throws, and close physical contact.  
- Injuries may occur, including sprains, strains, fractures, joint injuries, head injuries, bruising, and skin infections.

The student voluntarily assumes all risks associated with participation.

The student hereby releases, waives, and agrees not to sue Josh Key Brazilian Jiu-Jitsu, its owners, instructors, staff, volunteers, or affiliates for any injury, accident, or harm occurring before, during, or after participation, including injuries resulting from training, equipment, or other students.

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PROPERTY LOSS / DAMAGE DISCLAIMER

Josh Key Brazilian Jiu-Jitsu is not responsible for:

- Lost property  
- Stolen property  
- Damaged property  

Students are solely responsible for their belongings at all times.

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MEDIA RELEASE (PHOTO & VIDEO PERMISSION)

The student understands and agrees that:

- Photos and videos may be taken during classes and events.  
- These may be used for advertising, marketing, social media, and promotional materials.  
- Permission is granted for unlimited use without compensation.  
- This release remains valid unless revoked in writing.

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FINAL CONSENT & ACKNOWLEDGMENT

By signing below, the student confirms:

- They have read and understand this entire document.  
- They agree to all terms voluntarily.  
- They accept full responsibility for their participation and personal property.  
- They understand that failure to disclose accurate medical information may result in loss of membership without refund.

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SIGNATURES

Student Name: _

Student Signature: 

Parent/Guardian Signature (if under 18): 

Date: _

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