Please indicate your status: ___ Student ___Grad. ___Alumni ___Staff ___FAC Member

I am paying by: Cash_____ Check #_______ Money Order # __________ Evergreen ____________

Ju-Jitsu: Fall Semester $50.00 . Class hours are Tuesday & Thursdays from 8:00 -10:00 and Saturdays from 12:00 - 3:00 (Self Defense will be from 12:00 - 1:00)..

ACKNOWLEDGEMENT OF RISK: I know and understand that there are risks associated with my participation in the art of Ju-Jitsu and that these risks may result in my being injured. I hold Loyola College and the Ju-Jitsu Club and all instructors hired by said club. harmless from and against any and all claims that may arise resulting from my participation in the noted program. Further, I acknowledge that I have been advised to seek a physician's opinion regarding my physical fitness to participate in Ju-Jitsu. If under the age of 18, there must be a signature of a parent or guardian

Signature ____________________________________________________Date____________

In case of an emergency call: ______________________________________________________

A check made payable to "Loyola University" must accompany enrollment form. *No Refunds will be issued after the first week of scheduled class time,