SYSTEM Jiu-Jitsu Waiver & Release of Liability

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Mobile Phone Number* This field is required.
Please enter a valid phone number.
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Date of Birth* This field is required.
Date
Month
Day
Year
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Agrees that prior to participating in any activity, the participant will inspect the facilities and equipment to be used and, if the participant believes anything is unsafe, will immediately advise the coach, trainer, or other supervisor of such condition and will refuse to participate. Parent(s) and legal guardian(s) of minor participants (under 18 years of age) agree that they will instruct the minor participant to comply with this rule.* This field is required.
Agree
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Certifies that the participant is in good physical condition and has no disease or injury that would prevent or impair participation in this activity, and that no instructor, coach, manager, doctor, nurse, medical professional, athlete, trainer, or other person has advised the participant not to compete in a contact sport for any reason, and not to participate in this activity.* This field is required.
Agree
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Acknowledges and fully understands that each participant will be engaging in activities requiring physical contact, that by their very nature involve risk of serious injury, including permanent disability, paralysis, and death, and severe social and economic losses, including damage or loss of personal property, which might result not only from their own actions, inactions, or negligence but also the actions, inactions, or negligence of others, the rules of play, the conditions of the premises or of any equipment used. Furthermore, that there may be other risks not known to them or not reasonably foreseeable at this time.* This field is required.
Agree
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Voluntarily and knowingly accepts and assumes all the foregoing risk and danger involved with participation in martial arts training sports programs and other events and activities conducted by SYSTEM JIU-JITSU, LLC and its members, managers, and owners and accepts personal responsibility for the damages following such damage, loss, injury, infectious diseases, permanent disability, paralysis, or death.* This field is required.
Agree
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Releases acquits, waives, forever discharges, holds harmless, agrees to indemnify, and defend and covenants not to sue Nicholas Hession-Kugelman, Jason Flynn, SYSTEM JIU-JITSU, LLC., its members, managers, owners, employees, officers, directors, agents, instructors, volunteers, assistants, administrators, coaches, and System Jiu-Jitsu; and their affiliated clubs and organizations’ administrators, directors, agents, coaches, employees, supervisors; and other participants, participants’ parents and/or guardians; and sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of the premises used to conduct any event or training, all of which are hereinafter referred to as “releases”, from any and all liability, claims, damages, demands, costs, actions, causes of action, or suits of any nature or kind whatsoever which the undersigned, their heirs, parents, guardians, next of kin, executors, administrators, personal representatives, or assigns may have or claim to have, on account of or arising out of the personal injuries, death or damage to their person(s) or property or involving any impairment or damage to any right, including, but not by way of limitation, loss of time, loss of service, loss of income, or for expenses incurred, occurring to them because of or in any way relating to participation by the undersigned in activities of SYSTEM JIU-JITSU, LLC and any of its members, managers, owners, employees, officers, directors, agents, instructors, volunteers, assistants, administrators, coaches; and SYSTEM JIU-JITSU, LLC and its members, managers, owners, employees, officers, directors, agents, instructors, volunteers, assistants, administrators, and coaches or through the use of any and all facilities connected therewith, or caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.* This field is required.
Agree
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I / WE hereby grant to System Jiu-Jitsu, LLC, Jason Flynn, Nicholas Hession-Kugelman, and their media team, students, their successors, and their assignees the right to record my image and/or voice and use, on videotape, on film, on photographs, in digital media and any other form of electronic or print medium and to edit such recording at their discretion.* This field is required.
Agree
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I / WE HAVE READ THE ABOVE WAIVER AND RELEASE; AND MEDIA RELEASE AND UNDERSTAND THAT I / WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND SIGN IT VOLUNTARILY..* This field is required.
Agree
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I/we declare under penalty of perjury that the foregoing is true and correct.** This field is required.
Agree
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Signature of Participant / Guardian
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