Membership Waiver & Release of Liability Form

Membership Waiver & Release of Liability Form

Please fill out your details and read the waiver carefully before submitting.
Full Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Home Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Emergency Contact Name

First NameLast Name
Emergency Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Waiver & Release of Liability
I understand that participation in Brazilian Jiu-Jitsu, grappling, wrestling, self-defense training, fitness activities, sparring, competitions, and related activities at Rodriguez Jiu-Jitsu Academy (RJJA) involves inherent risks including injury, permanent disability, and death. I voluntarily assume all risks associated with participation. I certify that I am physically able to participate and release RJJA, its owners, instructors, coaches, employees, volunteers, and affiliates from liability arising from participation to the fullest extent permitted by Florida law. I authorize emergency medical treatment if necessary and understand that I am responsible for any resulting medical expenses. I agree to follow all academy rules and instructor directions.
I have read and agree to the waiver.
Photo and Video Release
Participant Signature
Minors Section
Parent/Guardian Name

First NameLast Name
Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Parent/Guardian Email
example@example.com
Parent/Guardian E-Signature
I acknowledge that I have read and agree to all terms.
Should be Empty:

Membership Waiver & Release of Liability Form

Minors Section