Once we receive the form below, we will contact you with more information.

JFit Registration Form

Conditions of Membership: Your request for membership with NUMA represents your agreement to abide by the rules, regulations, policies and codes of NUMA.

Full name

Date of Birth

Phone

Address

Emergency Contact Name

Emergency Contact Phone

Release of liability, Waiver of Claims
and Indemnity Agreement:

In consideration of NUMA accepting my application to participate in Fitness activities, I agree:

To waive any and all claims that may I have in the future against NUMA.
To release NUMA from any and all liability for any personal injury, death, property damage, expense and related loss, including loss of income that I or my next of kin may suffer as a result of my participation in this activity, due to any cause whatsoever, including negligence, breach of contract or breach of any statutory duty of care.
To hold harmless and indemnify NUMA from any and all liability for any damage to property of, or personal injury to, any third party, resulting from my participation in this activity.
To allow the use of my name, photographic image, and relevant personal information for the promotion of fitness and judo in the media, fitness and judo related publications & websites, and for use by governing judo and fitness associations, when deemed appropriate by NUMA.

I accept terms & conditions

Your Signature (parent/guardian if under age 18)

JFit Registration Form

Thanks for submitting!

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