TRUE JIU-JITSU AND FITNESS – Participation Waiver, Release, & Hold Harmless Agreement
Please complete this form to acknowledge your understanding of the risks and agreements required for participation at True Jiu-Jitsu and Fitness.
Section A – Participant Information
Please provide accurate participant and emergency contact details.
Participant Full Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Is the participant under 18?
*
Yes
No
Parent/Guardian Full Name (if participant is under 18)
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Section B – Assumption of Risk
Acknowledgement of inherent risks associated with Brazilian Jiu-Jitsu and related training.
Brazilian Jiu-Jitsu and related training involve inherent risks, including the risk of serious injury or death. By participating, you acknowledge and voluntarily assume all such risks associated with these activities.
I have read and agree to the Assumption of Risk statement above.
*
I agree
Section C – Medical Responsibility
Confirmation of medical fitness and responsibility for personal medical condition and expenses.
I confirm that I am physically able and/or medically cleared to participate in Brazilian Jiu-Jitsu and related activities. I accept full responsibility for my medical condition and any related expenses.
I have read and agree to the Medical Responsibility statement above.
*
I agree
Section D – Liability Waiver & Release (North Carolina)
Release of liability for injuries or death resulting from participation, except in cases of gross negligence or intentional wrongdoing.
I hereby release True Jiu-Jitsu and Fitness, its owners, staff, instructors, and affiliates from any liability for injury or death arising from participation, including ordinary negligence, but not for gross negligence or intentional wrongdoing.
I have read and agree to the Liability Waiver & Release statement above.
*
I agree
Section E – Hold Harmless & Indemnification
Agreement to defend, indemnify, and hold harmless the gym and related parties from claims arising from participation.
I agree to defend, indemnify, and hold harmless True Jiu-Jitsu and Fitness and related parties from any claims arising from my participation, my own negligence, or injuries caused to others. I acknowledge responsibility for attorney’s fees where permitted by North Carolina law and agree not to sue other students for ordinary supervised contact.
I have read and agree to the Hold Harmless & Indemnification statement above.
*
I agree
Section F – Gym Rules & Conduct
Agreement to follow gym rules and acknowledgement of consequences for misconduct.
I agree to follow all gym safety, hygiene, and anti-bullying rules, and understand that misconduct may result in suspension or termination of participation.
I have read and agree to the Gym Rules & Conduct statement above.
*
I agree
Section G – Photo & Media Release
Optional permission for use of photos and videos for promotional purposes.
Do you allow True Jiu-Jitsu and Fitness to use photos or videos of you for promotional media?
Yes
No
Section H – Electronic Signature
Electronic signature required. If participant is under 18, parent/guardian must sign.
Participant Signature (Parent/Guardian must sign if participant is under 18)
*
Date Signed
*
-
Month
-
Day
Year
Date
Submit Waiver
Submit Waiver
Should be Empty: