New Visitor/Member Sign-up

JIU JITSU PARTICIPANT WAIVER
Participant Information

• {first_name} - First name
• {name} - Last name
• {dob} - Date of birth
• {address} - Member address
• {phone} - Phone number
• Emergency Contact
• {contact_name} Contact Name
• {contact_phone} Phone #
• {contact_relation} - Emergency contact relation

Assumption of Risk
I understand that participation in Brazilian Jiu-Jitsu, No-Gi grappling, wrestling, self-defense
training, fitness activities, seminars, open mat sessions, and related activities involves inherent
risks including, but not limited to, cuts, bruises, sprains, fractures, joint injuries, concussion,
paralysis, serious bodily injury, and death. I voluntarily choose to participate and knowingly assume
all risks.
Release of Liability
In consideration of being permitted to participate, I release and hold harmless the academy, its
owners, instructors, employees, volunteers, contractors, and affiliates from any claims arising from
my participation, except where prohibited by applicable law or resulting from gross negligence or
willful misconduct.
Medical Authorization
I certify that I am physically able to participate. In the event of an emergency, I authorize the
academy to obtain emergency medical treatment for me. I understand that I am responsible for any
medical expenses incurred.
Academy Rules
I agree to follow instructor directions, practice good sportsmanship, maintain proper hygiene,
remove jewelry before training, and immediately release submissions when my training partner
taps. Failure to follow academy rules may result in suspension or removal.
Photography & Video Consent
I understand the academy may take photographs or video during classes, seminars, competitions,
and events for educational or promotional purposes.

I GIVE permission for my image and/or likeness to be used in print, social media, websites, and
other promotional materials.

Acknowledgment
I have carefully read this agreement, understand its contents, understand that I am giving up certain
legal rights, and sign it voluntarily.

• {sign_date} - Date document was signed (if applicable)
• - Name of the member or guardian signing the document (if applicable)