DZRSI Student Agreement


Every prospective student will first complete and submit this Agreement before enrolling in a DZRSI Program.


Register with the AJJF before filling out this Agreement – AJJF Registration

Professor Pat Brown DZRRT Scholarship

Will you be applying for the Professor Pat Brown Scholarship?

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In order to enroll in a DZRRT Program, you must complete the

DZRSI Student Agreement

Please fill out the form below to submit your application and then click send.

DZRSI Student Agreement Form

    In-personOnline Blended




    * Complete an AJJF background Screen and maintain a Clear Status for the duration of the program

    * I understand that the AJJF Background Screen fee is non-refundable

    * Pay all course fees

    *Sign the DZRSI Ethics Statement (This is different from the AJJF Black Belt Ethics Statement)

    *Be at least 18 years of age of older

    *Practice will involve physically giving and receiving bodywork in the course

    *Have a High School diploma, or GED, or demonstrate an ability to benefit from the course.

    *Have computer skills, or assistance as required, sufficient for the course work

    *Pass an interview on those skills with my Online Manager, if any portion of the course is online

    “Before and during the course, I will inform the Program Director of any personal health concerns relevant to the giving and receiving of bodywork. I understand that the information I share will be confidential.

    “My signature physically or electronically affirms my agreement to all of the terms above, my promise that all information provided is accurate to the best of my knowledge and that my intention is to participate in this program and to successfully complete all of the coursework.”

    Rev 7/20