Tertiary Email Address
Referral Program
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Name
Guardian Name (if signing up someone under 18)
Email
Phone Number
Sms Opt-In
By opting in to SMS, the Person agrees to receive announcements and billing alerts from Valens Jiu Jitsu Academy .
Standard messaging rates may apply. Messaging cadence may vary. Reply STOP to opt out.
Birthdate
Emergency Contact Name
Emergency Contact Phone Number
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