Signup

  Waiver of Liability, Assumption of Risk, and Indemnity Agreement   

WAIVER . In consideration of permission to use, today and on all future dates, the property, facilities, staff, equipment, services, and programs at Jiu Jitsu Gypsy, Assumption of Risk, and Indemnity Agreement, I, for myself, or for the minor participant named below, my heirs, children, parents, guardians, executors, personal representatives, administrators, successors and assigns, do hereby release, acquit, waive, discharge, and covenant not to sue the Jiu Jits Gypsy Martial Arts Program, or any of the directors, officers, managers, employees, agents, affiliates, attorneys, spouses, heirs, executors, administrators, successors, assigns, organizers, volunteers, sponsors, affiliated organizations, coaches, instructors, managers, trainers or doctors, or any other persons involved from liability from any and all claims including the negligence of the Jiu Jitsu Gypsy Martial Arts Program resulting in personal injury, accidents or illnesses (including death), and property loss arising from, but not limited to, participation in activities, classes, observation, and use of facilities, premises, or equipment.  

ASSUMPTION OF RISKS . Physical activity by its very nature carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The Jiu Jitsu Gypsy Martial Arts Program has facilities for and provides for martial arts activities. Some of these activities involve strenuous exertions of strength using various muscle groups, some involve quick movements involving speed and change of direction, and others involve sustained physical activity which places stress on the cardiovascular system.  

I certify that I, for myself or the parent(s) and/or legal guardian(s) of the minor participant named below, am familiar with martial arts and training in connection with martial arts and other activities, including but not limited to Brazillian Jiu Jitsu, wrestling, Grappling and self-defense. I am aware, acknowledge and agree that by the very nature of martial arts, and the physical contact involved, there is a high risk of injury related to participating in martial arts, and I assume all risk relating to my participation in martial arts or other activities in the Jiu Jitsu Gypsy Martial Arts Program. 

The specific risks vary from one activity to another, but the risks range from  (1) minor injuries such as scratches, bruises, and sprains, (2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, broken bones, and concussion, (3) catastrophic injuries including paralysis and death. 

INDEMNIFICATIONS AND HOLD HARMLESS . I further agree, for myself or the minor participant named below, to INDEMNIFY AND HOLD the directors, officers, instructors, volunteers, sponsors, and affiliated organizations HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages and liabilities, including attorney’s fees brought as a result of my involvement at the Jiu Jitsu Gypsy Martial Arts Program and to reimburse them for any such expenses incurred. 

I, or the parent(s) and/or legal guardian(s) of the minor participant named below, have read this Waiver of Liability, Assumption of Risk, and Indemnity Agreement, and I fully understand its terms. I understand that by entering into this agreement I am giving up substantial rights, including the right to sue. I understand that this agreement is incorporated by this reference as a part of my application form for participation in the Jiu Jitsu Gypsy Martial Arts Program. I also understand that entering into this agreement is a condition precedent to and is consideration for the privilege of participating in the Jiu Jitsu Gypsy Martial Arts Program. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature to make a complete and unconditional release of all liability to the greatest extent permitted by the laws of the State of Arizona. If any portion of this agreement is held invalid, I agree that the balance of it shall nevertheless continue in full force 

Physician Verification; Authorization for Medical Treatment; Photography, Video, and Promotional Release; Termination of Participation  

PHYSICIAN VERIFICATION . My physician has examined me, or the minor participant named below, and certified that I or the minor participant named below am in good physical condition and have no disease or injury that would impair my performance or physical condition in training for or participating in the Jiu Jitsu Gypsy Martial Arts Program. I recognize that if I have any existing injuries that may affect my performance, I cannot participate in the Jiu Jitsu Martial Arts Program without a report from my physician authorizing my participation, and I verify that if I have any such injuries, the requisite report is attached to this form. I further certify that no coach, doctor, nurse, athletic trainer or other person has advised me, or the minor participant named below, not to participate in the Jiu Jitsu Gypsy Martial Arts Program. 

AUTHORIZATION FOR MEDICAL TREATMENT . Further, in the event I, or the minor participant named below, am injured, either at high mountain Jiu Jitsu School, or elsewhere during my participation in the Jiu Jitsu Martial Arts Program activities, I, or the parent(s) and/or legal guardian(s) of the minor participant named below, hereby grant permission to any and all of the licensed athletic trainers, emergency medical technicians, nurses or doctors to provide me with medical assistance and treatment and, if needed, to transport me to a hospital or other treatment facility. For myself and for my heirs, children, parents, guardians, executors, personal representatives, administrators, successors and assigns, I forever release, acquit, waive, discharge, and covenant not to sue the Jiu Jitsu Gypsy Martial Arts Program, or any of the organizers, volunteers, sponsors, affiliated organizations, coaches, instructors, managers, athletic trainers, emergency medical technicians, nurses or doctors, or any other persons involved any injury I sustain or suffer in connection with the Jiu Jitsu Martial Arts Program or said medical assistance or treatment. I accept responsibility to pay for any and all financial obligations incurred as a result of any medical assistance or treatment provided in connection with any injuries or illness that I may sustain in the Jiu Jitsu Martial Arts Program.  

PHOTOGRAPHY, VIDEO, AND PROMOTIONAL RELEASE . For myself, or the minor participant named below, and for my heirs, children, parents, guardians, executors, personal representatives, administrators, successors and assigns, I, or the parent(s) and/or legal guardian(s) of the minor participant named below, hereby gives permission an authorization to the Jiu Jitsu Gypsy Martial Arts Program and its designees, agents and applicable media vendors to use and reproduce any still photographs, video tape or any other media forms that include my name or likeness, or the name or likeness of the minor participant named below, and use or reproduce any recording or other media form that includes my voice, in any approved Jiu Jitsu Gypsy Martial Arts Program publication, Website, podcast, audio recording, promotional materials, video medium (including but not limited to video clips) or any other medium. The undersigned releases and hold harmless the Jiu Jitsu Gypsy Martial Arts Program, and their designees, agents and applicable media vendors from any and all claims of libel, slander, invasion of the right of privacy or publicity, or any other claim based on the use of my name, likeness or voice, and any and all damages, costs and expenses that may directly or indirectly arise from the use of my name, likeness or voice.  

TERMINATION OF PARTICIPATION . I, or the parent(s) and/or legal guardian(s) of the minor participant named below, understand and agree to abide by all policies, rules, and regulations. Participant understands that, in its sole discretion, the Jiu Jitsu Gypsy Martial Arts Program or its representative may terminate my or the minor participant named below participation at any time should my actions or general behavior impede the operation of the Jiu Jitsu Gypsy Martial Arts Program or the rights or welfare of any person. Reasons for termination may include, but are not limited to: inappropriate conduct or other behavior by myself or the minor participant named below deemed detrimental to the best interests of the Jiu Jitsu Gypsy Martial Arts Program such as persistent use of vulgar or inappropriate language; physical violence; emergencies; or health or safety considerations.  

I, or the parent(s) and/or legal guardian(s) of the minor participant named below, have read this Physician Verification; Authorization for Medical Treatment; Photography, Video, and Promotional Release; and, Termination of Participation, and I fully understand its terms. I understand that this agreement is incorporated by this reference as a part of my application form for participation in the Jiu Jitsu Gypsy Martial Arts Program. I also understand that entering into this agreement is a condition precedent to and is consideration for the privilege of participating in the Jiu Jitsu Gypsy Martial Arts Program. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature to make a complete and unconditional release of all liability to the greatest extent permitted by the laws of the State of Arizona. If any portion of this agreement is held invalid, I agree that the balance of it shall nevertheless continue in full force and effect.