Participation Waiver And Release Form

Participant Name

First NameLast Name

DOB

Date

Contact Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Terms and Conditions

I hereby agree to participate in the required physical activities and exercises as required for certification within the Brazilian Jiu Jitsu classes conducted by Tenacity Jiu Jitsu on the basis of the terms and conditions set out below:

1. I hereby acknowledge an understanding of and agree to participate in physical demanding activities that if done incorrectly could be detrimental to my health.

2. I acknowledge that the training, while conducted in the safest possible conditions and under qualified supervision, involves physical contact and inherent risks and I accept those risks. I agree to conduct myself in a safe and mature manner in accordance with the instructions from my instructors. I indemnify Tenacity Jiu Jitsu, its proprietors, agents and officers, including all instructors, staff members, and students against any loss or damage suffered by them in connection with my participation in the training.

3. I confirm I am physically capable of participating in this training and that I have no existing medical condition which precludes or should reasonably preclude my participation.

4. I agree to release Tenacity Jiu Jitsu, its proprietors, agents and officers, including all instructors, staff members, and students from any liability whatsoever in connection with my participation in the required physical activities and exercises within the Brazilian Jiu Jitsu class training programs. Without limitation, this includes all loss or damage or injury incurred as a direct or indirect result of my participation.

5. I agree that I will conduct myself in an appropriate manner and will always act in a manner that is in the best interests Tenacity Jiu Jitsu.

Note: The required training and exercises within the Brazilian Jiu Jitsu Training classes consists of, but not limited to the following: Takedowns, strangle holds, joint locks, grappling and wrestling techniques, etc. and participants are required to complete the questionnaire below as a prerequisite before starting the course for assessment of any special needs and/or considerations.

Has your doctor ever said you have a heart condition or vascular disease?

Have you ever experienced chest pains?

If you ansered "yes" to chest pain, was this within the past 12 months?

Do you ever feel faint, dizzy, lose balance or consciousness?

Has your doctor ever said you have high or low blood pressure?

Are you taking any medication for blood pressure or a heart condition?

Do you have a bone or joint problem that could be made worse by a change in your physical activity?

Are you diagnosed with asthma or any other respiratory problems?

Do you live with diagnosed diabetes?

Are you diagnosed with epilepsy?

Are you diagnosed with any medical condition or allergy not listed above?

Please specify below:

Do you know any other reason you should not participate in this type of physical activity?

Please specify below:

Please note: If you have answered yes to any of the above questions, or if you are injured throughout your course of active membership, you may be required to provide a doctor's certificate to clear you for participation in Tenacity Jiu Jitsu classes. Do you accept?

I give permission for Tenacity Jiu Jitsu to responsibly take and use photographs, video, or digital images of me/my child on official social media channels (such as Facebook, Instagram, or LinkedIn), the club website and displayed within the walls of the Tenacity Jiu Jitsu building. I understand that no full names or personal identifying details will be published alongside these images.

By signing below you acknowledge and agree to the above terms and conditions.

To the best of my knowledge, I have answered all questions truthfully. I understand and agree that it is my responsibility to inform Tenacity Jiu Jitsu of any conditions or changes in my/my child's health, now and ongoing, which may affect my/my child's ability to participate safely in required exercises/activities.

Parent/Guardian Name (required for participants under 18 years of age)

First NameLast Name

Participant Signature

Today's Date

Date