Adult Consent Form Logo
  • Profile Information

    Martial Arts Intake Form
  •  -
  •  -
  •  - -
  •  -
  • Tell Me About Yourself

    Let's Connect!
  • ** We have a ZERO drug tolerance policy. DO NOT train while under the influence. If found high, drunk, or etc... your training session will be stopped and you will be asked to leave the premises immediately.

  • Yours in Jiu Jitsu,

    Fluxo BJJ Brampton

    16/17 - 470 Chrsyler Drive

    Brampton, ON L6S 0C1

    (905) 458 - 7364

     

  • COVID-19 Liability Waiver

  •  - -
  • I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing.


    I further acknowledge that Fluxo Brazilian Jiu-Jitsu has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.


    I further acknowledge that Fluxo Brazilian Jiu-Jitsu can not guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families.


    I voluntarily seek services provided by Fluxo Brazilian Jiu-Jitsu and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment.


    I attest that:


    * I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.


    * I have not traveled internationally within the last 14 days.


    * I have not traveled to a highly impacted area within the United States of America in the last 14 days.


    * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19.


    * I have not been diagnosed with Coronavirus/Covid-19 and not yet cleared as non contagious by state or local public health authorities.


    * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.


    I hereby release and agree to hold Fluxo Brazilian Jiu-Jitsu harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of the salon, or that may otherwise arise in any way in connection with any services received from Fluxo Brazilian Jiu-Jitsu. I understand that this release discharges Fluxo Brazilian Jiu-Jitsu from any liability or claim that I, my heirs, or any personal representatives may have against the school with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from Fluxo Brazilian Jiu-Jitsu. This liability waiver and release extends to the space together with all owners, partners, and employees.

  • Clear
  • Liability Waiver

  • ACKNOWLEDGEMENT OF RISK AND RELEASE OF LIABILITY

    For Participants Over the Age of Majority or signed for by guardian in the Province or Territory in which the Athletic Activities provided by the Organization.


    WARNING: THIS AGREEMENT WILL AFFECT YOUR LEGAL RIGHTS.
    READ IT CAREFULLY!

    Every Person Read and Understand this Waiver Before Participating in physical
    activities. The following waiver of all claims, release from all liability, assumption of all risks, and other terms of this agreement are entered into by me (the “Participant) with and for the benefit of: their directors, officers,
    employees, volunteers, business operators, agents and site property owners or Occupiers (the“Organization”). Occupiers is defined in accordance with the definition of Occupiers contained in the Occupiers Liability legislation applicable to the Province or Territory in which the physical activities are provided by the Organization. Please Initial Each item below after Reading and Understanding each item: “Athletic Activities” include but are not limited to contact and non-contact sports, fitness activities,martial arts, personal training instruction and activities, use of facilities, and fitness programs and services provided to the Participant by Trinity Collective and Fluxo Brazilian Jiu-Jitsu.

    THIS ACTIVITY WAIVER & RELEASE (this “Agreement”) dated from the participants initial appointment between Fluxo Brazilian Jiu-Jitsu (of the first part) and Trinity Collective of 470 Chrysler Dr, unit 16/17, Brampton ON, L6S 0C1 (the “Activity Provider”) (of the second & third part).

    * IN CONSIDERATION OF the covenants and agreements contained in this Agreement and other good and valuable consideration, the receipt of which is hereby acknowledged, the parties to this Agreement agree as follows: Consideration 1. Being of lawful age and in consideration of being permitted to participate in the activity described below, the Participant releases and forever discharges the Activity Provider, its owners, directors, officers, employees, agents, assigns, legal representatives and successors from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person or property, including injury resulting in the death of the Participant, which has been or may be sustained as a consequence of the Participant's participation in the activity described below, and not withstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Activity Provider. 2. The Participant understands it would not be permitted to participate in the activity described below unless it signed this Agreement.

    Details of Activity

    The Participant will participate in either of the following activities: Boxing, Brazilian Jiu-Jitsu, Muay Thai, and/or Personal Training.


    * Concurrent Release 4. The Participant acknowledges that this Agreement is given with the express intention of effecting the extinguishment of certain obligations owed to the Participant and with the intention of binding the Participant's spouse, heirs, executors, administrators, legal representatives and assigns. Fitness to Participate 5. The Participant acknowledges that the Participant does not have any physical limitations, medical ailments, physical or mental disabilities that would limit or prevent the Participant from participating in the above mentioned activity. If required, the Participant will obtain a medical examination and clearance. Full and Final Settlement 6. The Participant hereby acknowledges and agrees that the Participant has carefully read this Agreement, that the Participant fully understands the same, and that the Participant is freely and voluntarily executing the same. 7. The Participant understands that by signing this Agreement, the Participant agrees to be forever prevented from suing or otherwise claiming against the Activity Provider for any property loss or personal injury that the Participant may sustain while participating in or preparing for the above noted activity. 8. The Participant has been given the opportunity and has been encouraged to seek independent legal advice prior to signing this Agreement.


    * 9. This Agreement contains the entire agreement between the parties to this Agreement and the terms of this Agreement are contractual and not a mere recital. Governing Law 10. This Agreement will be governed by and construed in accordance with and governed by the laws of the Province of Ontario.

     

  • ** We have a ZERO drug tolerance policy. DO NOT train while under the influence. If found high, drunk, or etc... your training session will be stopped and you will be asked to leave the premises immediately.

  • Yours in Jiu Jitsu,

    Fluxo BJJ Brampton

    16/17 - 470 Chrsyler Drive

    Brampton, ON L6S 0C1

    (905) 458 - 7364

  • Should be Empty: