WARNING, WAIVER, RELEASE OF LIABILITY AND INDEMNITY AGREEMENT TO PARTICIPATE
*'Our business reserves the right to refuse service to anyone, at any time, for whatever reason.'
This Warning, Waiver, Release of Liability, and Indemnity Agreement to Participate (hereinafter "Agreement") is made between {name} (hereinafter "Participant") and Excel Jiu Jitsu MMA & Fitness, Michio Grubbs, and all associates including but not limited to: any affiliated coaches, instructors (permanent, substitute, volunteer, or visiting), applicable owners and staff, personnel and officials (all hereinafter referred to as "The School").
*Initial the following to acknowledge that you have read and agree to the terms of this Agreement, (Participating Adult or Parent/Guardian Responsible):
1) Assumption of Risk: Participant acknowledges and fully understands that he/she will be engaging in a contact sport, namely Jiu Jitsu, Boxing, MMA, that carries the risk of serious injury including permanent disability and/or death. Participant fully acknowledges his/her participation in The School, will assume all said risks. Participant accepts responsibility for all damages legal & otherwise, in the possible event of personal injury, damages and/or death, as well as other risks not reasonably foreseeable at this time.
2) Release of Claims & Damages: Participant, on behalf of himself/herself as well as the participant's family, heirs, executors, administrators, and assigns hereby releases, indemnified, waives, and otherwise discharges and holds harmless The School of any and all injury and loss howsoever caused to any person and/or property including but not limited to claims, liability for damages, demands, losses (social and economic), personal injury or otherwise in the event of injury including permanent disability and/or death.
3) NO Legal Action: Participant agrees and hereby stipulates not to sue or bring legal action in any form against The School or against Excel Jiu Jitsu MMA & Fitness, Michio Grubbs, and any other owner(s) and/or personnel of the school in the event of injury and/or damages including but not limited to personal injury and/or death, claims, liability for damages, demands, losses (social and economic) caused or alleged to be caused in whole or in part by the negligence of The School.
4) Waive & Discharge: Participate also agrees to release, indemnify, waive, hold harmless, & otherwise discharge The School from any and all liability resulting from any damage, personal, and otherwise, as outlined above in connection with participation at The School or participation in activities sponsored or connected with The School including but not limited to travel to and from The School, tournaments, practice, clinics, events, and any other venues of which The School is a vendor or participant.
5) Received Copy: Participant acknowledges that he/she has received a completely executed copy of this Agreement.
6) Agreement: Participant confirms that there are no verbal presentations or terms other than those specified in this Agreement.
7) Model Release: Participant acknowledges and consents that he/she may be photographed and/or filmed while attending any classes, workshops, tournaments, or seminars and he/she gives consent to The School and any affiliates to use any and all photos, video footage and/or video streaming for promotional sales, publicity, and advertising purposes for all media including the internet.
AS EVIDENCED BY HIS/HER SIGNATURE BELOW, PARTICIPANT OR PARENT HAS READ THE ABOVE WARNING, WAIVER & RELEASE OF LIABILITY AND AGREEMENT TO PARTICIPATE AND FULLY UNDERSTANDS THAT HE/SHE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING SAID AGREEMENT. KNOWING THIS, THE PARTICIPANT/PARENT SIGNS THE AGREEMENT VOLUNTARILY. PARTICIPANT AGREES TO PARTICIPATE KNOWING THE RISKS AND CONDITIONS INVOLVED AND DOES SO ENTIRELY OF HIS/HER OWN FREE WILL. PARTICIPANT AFFIRMS THAT HE/SHE IS AT LEAST 18 YEARS OF AGE OR IF LESS THAN 18 YEARS OF AGE, HAS OBTAINED THE REQUIRED CONSENT OF HIS/HER PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.
*FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT THE TIME OF REGISTRATION)
This is to certify that I, as parent or guardian with responsibility for this participant, do consent and agree to his/her release as provided above, of The School and applicable affiliates as defined above, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless The School from any and all liabilities incident to my minor child's involvement of participation in these programs as defined above, even if arising from negligence alleged to otherwise on behalf of The School. I have instructed the minor participant as to the above warnings and conditions and their ramifications.
Participant Name:
Parent/Guardian Name (If Applicable):
Date: {sign_date}
Have you/your child ever trained Martial Arts or been involved in a fitness program before?
Yes No
If yes, when/where/rank?
What other activities are you/your child currently involved in?
Which training programs are you interested in?
Jiu Jitsu MMA Boxing Fitness Unlimited Personal Training
Do you currently have medical insurance?
Yes No
Who?