SandersBJJ Waiver

Liability Waiver and Participant Agreement

This waiver must be completed prior to participation in training.
Participant Full Legal Name*
Date Of Birth*

MonthDayYear
Is Participant a minor?*

YesNo
Parent/Guardian Full Legal Name*

First NameLast Name
Contact Information
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian Phone Number*
Please enter a valid phone number.
Parent/Guardian Email*
example@example.com
Does the participant have any medical conditions, injuries, or health concerns we should be aware of (including asthma, heart conditions, use of an inhaler, allergies, or other relevant medical issues)?*

YesNo
If yes, please explain*
I certify that I (or my child) am physically fit to participate in strenuous physical activity and have not been advised otherwise by a medical professional. I understand that it is my responsibility to consult a physician regarding any medical concerns prior to participation.*

I Agree
Emergency Contact Information
Emergency Contact Name*
Relationship to Participant*
Release of Liability and Assumption of Risk
Signature of Participant*

Powered by Jotform SignClear
Parent/Guardian Signature*

Powered by Jotform SignClear
Printed Name of Participant*
Printed Name of Parent/Guardian*
Today's Date*

MonthDayYear
Date
Should be Empty:

Liability Waiver and Participant Agreement