Name
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First Name
Last Name
Gender
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Male
Female
Date of Birth
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MM
DD
YYYY
Email
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Phone
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(###)
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Allergies?
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If so please explain:
Serious Health Conditions?
Address
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Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Participating Minors Name (if applicable)
Participating minor Email (if applicable)
Phone
(###)
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Emergency Contact:
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First Name
Last Name
Emergency Contact Relationship:
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Emergency Contact Phone
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(###)
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Why do you want to train Jiu Jitsu?
Medical and Media Waiver:
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In consideration of being permitted to participate in any way in the Martial Arts Program indicated below and/or being permitted to enter for any purpose any restricted area (herein defined as any area where in admittance to the general public is prohibited), the participant or the parent(s) and/or Legal Guardian(s) of the minor participant named below agree:
The participant, the parent(s) and/or Legal Guardian(s) of the minor participant will instruct the minor participant that, prior to participating in the Martial Arts activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe and REFUSE TO PARTICIPATE further.
I/We fully understand and acknowledge that:
There are risks and dangers associated with participation in Martial Arts events and activities which could result in bodily injury partial and/or total disability, paralysis, and/or death. The social and economic losses and/or damages, which could result from these risk and dangers described above, could be severe. These risks and dangers may be caused by the action, inaction, or negligence of the participate or the action, inaction or negligence of others, including, but not limited to, the Releasees named below.
There maybe other risks not known to us or are not reasonably foreseeable at this time.
I/We accept and assume such risks and responsibility fore the losses and/or damages following such injury, disability, paralysis, and/or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
I/We HEREBY RELEASE, WAIVE, DISCHARGE ANDCOVENANT NOT TO SUE the Martial Arts facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the Martial Arts event or program, premises and event inspectors, underwriters, consultants, and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the Martial Arts facility or events held at such facility and each of them, their directors, officers, agents, employees, all for the purpose herein referred to as “Releasees”...From all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next of kin for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the event(s) caused, alleged to be caused, in whole or in part by the negligence of the Releasee or otherwise.
I/We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressly acknowledge that INJURIES RECEIVED MAY BE COMPOUND OR INCREASE BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF THE RELEASEES.
EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waive, and indemnity agreement is intended to be as broad and inclusive as is permitted but the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
On behalf of the participant and individually, the undersigned participant, parent(s) and/or Legal Guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the participant, the parent(s) and/or Legal Guardian(s) of the minor participant, will reimburse the Releasee for the money which they have paid to the participant, or on his or her behalf and hold them harmless.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT AND INDUCEMENT, ASSURANCE OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Martial Arts School: The JiuJitsu Training Institute (HammahFit Inc.) 14327 Imperial Hwy La Mirada Ca 90638
Medical and Media Waiver
(required)
Medical and Media Waiver I hereby approve the minor's or my application for membership at The JiuJitsu Training Institute and give my consent to I or the minor being given a physical examination or treatment by a physician or hospital in case of a medical emergency. I further agree to me or the minor taking part in the club’s various athletic, cultural and social activities and will not hold the members of the board, staff, leaders or volunteers responsible or liable in any way for harm or injury which may occur while participating in the same. It is agreed that the parent or guardian will not hold The JiuJitsu Training Institute responsible for the welfare or whereabouts of the member. Professional supervision will be provided to children inside our facility only. If the Parent or Guardian does file a complaint against the institute the Parent or Guardian agrees to pay for The JiuJitsu Training Institute’s legal fees. I further grant The JiuJitsu Training Institute and the media, in any form, permission to publish/use photographs or videotape footage of my son/daughter/myself for any purpose relating to The JiuJitsu Training Institute and release The JiuJitsu Training Institute and any media of responsibility from the use of such photographs or footage.
Confirmation of Waiver of Liability:
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I HAVE READ AND AGREE TO THE FOLLOWING WAIVER OF PARTICIPATION. I hereby assume full responsibility and liability for all damages, injuries and losses that I or my child may sustain or incur while participating in or watching during my entire tenure as a trial member or student of The JiuJitsu Training Institute (HammahFit Inc). I realize that serious injury is common place in martial arts participation such as the one I am hereby entering and that death is a possibility. I also realize that if I or my child are injured, I or my child might be disfigured, disabled and/or rendered unable to work again. By entering into this trial and/or membership I agree to and fully accept and assume liability for any and all injuries that I or my child may incur expressly give up and waive any and all claims that I or anyone acting on my behalf or through me might have against The JiuJitsu Training Institute (HammahFit Inc) , it's board members, the promoters, operators, sponsors, officials, participants, non-participants, or volunteers for any injury regardless of its nature, effect or affect on me as a result of mine or my child's participation and/or presence at The JiuJitsu Training Institute (HammahFit Inc) classes or training at The JiuJitsu Training Institute (HammahFit Inc). at any point in time. Jiu-Jitsu is a full contact activity. In participating in this activity at The JiuJitsu Training Institute (HammahFit Inc), could potentially expose you to Covid-19. I understand that The JiuJitsu Training Institute (HammahFit Inc). cannot be held liable for any exposure to the COVID-19 virus. Symptoms of COVID-19 include: Fever, Fatigue, Dry Cough, Difficulty Breathing. I agree to the following: I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 14 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days. I authorize, and agree to hold harmless, whatever medical personnel that may be present at the The JiuJitsu Training Institute (HammahFit Inc) to take any action necessary, should I become injured. I represent that I and or my child are in good health; that I and or my child are not presently, nor will I or my child participate while under the influence of any drug or medication; that no one affiliated with The JiuJitsu Training Institute (HammahFit Inc). has encouraged me to enter or made any representations regarding mine or my child's fitness or ability to participate; 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. In case of minors under 18 years old. Furthermore, if the competitor is a minor I, hereby certify that I am parent and/or legal guardian of the above named minor who has been given my express permission to participate in the trial or membership for which we are registering. And, that I have read and understood every provision of the release of liability and that I am legally competent to and freely enter into this release of liability and assume all risk on behalf of the minor (participant) named herein and any and all successors, assigns or any other representative acting upon the minor's behalf.
Type Full Name For Waiver Confirmation
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