Sign up Step 1 of 6 16% Student DetailsAre you over 18 and applying for yourself or as a parent/guardian?(Required) Self (Over 18) Guardian Student Name(Required) First Last Guardian Name(Required) First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 Town Post Code Occupation(Required)Student Gender(Required)Student Date of Birth(Required) DD slash MM slash YYYY What type of membership do you want?(Required) Standard Membership (ongoing fortnightly payment) Casual / Trial Membership (per class or concession card) School Term (10 weeks) Standard Membership(Required) Kids ($55 fortnightly) Youth ($60 fortnightly) Adults ($64 fortnightly) Family Deal School Term 4 (6 weeks remaining)(Required) Kids ($165) Youth ($180) Family Deal Family Deal Name(Required)Please enter a family name so we can group together the applications per family.Fill out the form for each member and we will contact you with special payment instructions for the family discount.Casual Option(Required) Casual Classes - $25 per class Concession Card Concession Card(Required) 5 Classes ($115) 10 Classes ($200) 5 classes within 4 consecutive weeks. 10 classes within 8 consecutive weeks.This field is hidden when viewing the formWhich classes do you wish to attend?(Required) Kids (No-Gi) Youth Fundamentals (No-Gi) Advanced Youth (Gi) Women Fundamentals (No-Gi) Adults Advanced (Gi / No-Gi) Torque Uniform(Required) Torque Gi Uniform ($200) Torque No-Gi Uniform ($65) Already own Torque uniform (previous members) Martial Arts historyHave you done martial arts before?(Required) Yes No Martial art(Required)ie BJJ, Karate, WrestlingGrade achievedie Belt colourYears trainedMonthsMedical Conditions and EmergenciesDo you have any medical conditions?(Required) Yes No Name and identify any physical impairments or medical conditions that currently affect you (Eg. Heart disease, shortness of breath, asthma, allergies, epilepsy, high/low blood pressure, diabetes, dizzy spells, bleeding disorders, pregnancy, history of unconsciousness, knee/hip/shoulder issues) and/or any medications that may impair reaction time or judgment.Medical condition(Required)Please provide detailsDo you have any current injuries?(Required) Yes No Details(Required)Are there any special needs we should be aware of, such as but not limited to, ASD, ADHD?(Required) Yes No Details(Required)Emergency Contact Name(Required) First Last Emergency Contact Phone(Required)Relationship(Required)Emergency contact relationship to studentAuthority for First Aid, medical treatment and indemnity:(Required) I AUTHORISE THE INSTRUCTOR/S AND OTHER OFFICIALS to give First Aid to me or my child in the event of injury and to arrange for me or my child to be transported to hospital for medical treatment.Jiu-Jitsu can have high risks:(Required) It has been explained to me and I understand that training, practicing or participating in Jiu-Jitsu is dangerous and that I must at all times abide by the rules of the academy and any instruction provided to me by the academy and those instructing me. I will always obtain clarification before proceeding if those rules or the instruction is not understood. Exclusion of ApplicantHas a medical practitioner or equivalent professional, or a martial arts club or organisation ever excluded you from participating in martial arts in the past?(Required) Yes No ETIQUETTE-AND-MAT-RULES-TORQUE-INTERNATIONAL Gym Culture We’re more than just a place to train — we’re a team. Everyone who comes to the gym contributes to keeping it running smoothly. That means: Helping tidy the mats and common areas before and after class. Supporting each other during training — offer tips, assist newer members, and help your teammates improve. By pitching in, you help maintain a safe, fun, and welcoming environment where everyone can learn and grow.Terms and Conditions This agreement is between the participant and S.Thomas Projects Limited, (hereinafter referred to as “TORQUE KAITAIA”). I have read and understood the “Torque International School of Brazilian Jiu-Jitsu and Self Defense Code of Conduct, Etiquette and Mat Rules” policy and agree to abide by the standards required. The timetable and classes are subject to change at the discretion of the gym. On occasion, classes may be cancelled or rescheduled due to instructor illness, public holidays, or unforeseen circumstances. Membership fees cover access to the training program overall, not a guarantee of any specific class. The gym will make reasonable efforts to notify members of cancellations in advance and may offer substitute classes or training where possible I understand the inherent risk in partaking in this form of physical activity; and understand the possible strenuous nature that is involved with the training which could result in injury associated with my participation. I represent that I am in good health; that I am not presently, nor will I participate while under the influence of any drug or medication; that I have read and understood every provision of this release; and that I am legally competent to and freely enter into this waiver, release and assumption of risk agreement. I agree to allow TORQUE KAITAIA and the associated Torque International academy to use pictures, film and/or likeness of me for advertising purposes. I also give my consent to posting class photos on the TORQUE KAITAIA Facebook, Instagram page and website. In the event I chose not to allow this, I agree that I must inform TORQUE KAITAIA of this in writing. I acknowledge that where any of my personal information is collected by TORQUE KAITAIA, I authorise the collection and use of my information by TORQUE KAITAIA and the academy for promotional activities. (Excluding health/medical information) Any litigation involving the parties of this Agreement shall be brought solely within New Zealand and shall be within the exclusive jurisdiction of the courts in New Zealand. If at any time any part of this Agreement is held by a court of competent jurisdiction to be unreasonable, illegal, invalid or unenforceable for any reason whatsoever, that term will be enforced to the maximum extent permissible so as to affect the parties’ intent and the remainder of the agreement will continue in full force and effect. I agree to indemnify TORQUE KAITAIA against all costs, whether commission, legal fees or otherwise, incurred by you or your duly authorised agents relating to any moneys, goods or services that may be outstanding from time to time pursuant to the terms of this Agreement. I understand that by signing this form I agree to abide by all rules and policies of TORQUE KAITAIA its associated organisations. Injury Waiver and General Release Clause: Members acknowledge that participation in training and competition exposes you to a possibility of personal injury, and hereby release the Academy’s and TORQUE and its associated organisations, officers, directors, employees, trainers, members, independent contractors and affiliates from any and all liability from property damage, personal injuries, or other claims arising from connection with your participation in the program including claims that are known and arising from or in connection with your participation in the program including claims that are unknown, foreseen, unforeseen, future or contingent. I agree to waive claims that I have or may have in the future with TORQUE, its directors, officers, employees, agents, volunteers and independent contractors (all of whom are collectively “the parties”). Terms and Conditions(Required) I agree to the terms and conditions.I hereby certify and declare that all the information contained in the declarations above is true and accurate at this date and that I consent to receiving (or where the applicant is under 18 years of age; the applicant receiving) instruction in and training, practicing and participating in Jiu-Jitsu at TORQUE KAITAIA. Members acknowledge that you have read and fully understand the membership form for Brazilian Jiu-Jitsu and self defense classes, terms and conditions, injury waiver and general Release clause, and the code . This agreement is binding on you, your spouse, your children, legal representatives and assignees.
