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ALLIANCE JIU-JITSU NORTHWEST ARKANSAS

1345 E Lowell Ave, Cave Springs, AR 72718.



PARTICIPATION AGREEMENT

In the consideration of the opportunity to participate (or to have my child or guardian participate) in activities conducted by, and to use the facilities and any premises owned/leased/rented by, Alliance Jiu Jitsu of NWA, LLC and its affiliates in the performance, instructions, lessons of jui jitsu or any martial arts, sparring, weapons training, personal training, general exercise, and all other exercise related training (hereinafter collectively called “Martial Arts”), I hereby understand and agree to this Participation Agreement and to the terms hereof as follows: 1. ACKNOWLEDGEMENT. I acknowledge that Martial Arts is an action sport and recreational activity involving movement in three dimensions and that such activity is subject to mishap and even injury to or death of participants. I understand I may suffer broken bones, internal injuries, paralysis, or fatal injury, as well as the loss of or damage to personal property, while participating in the sport of Martial Arts. I also recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable that this time. 2. RELEASE AND DISCHARGE. I hereby forever release and discharge ALLIANCE JUI JITSU OF NWA, LLC and its affiliates, as well as all other participants of Martial Arts, volunteers, students, ALLIANCE JUI JITSU OF NWA, LLC officers, directors, elected officials, agents, employees, representatives and owners of equipment and land and buildings used for Martial Arts activities (hereinafter collectively referred to as “Released Parties”), from any and all liability, claims, damages, demands or causes of action that I, my child, or my or my child’s representatives may hereafter have for injuries, loss of life, and all other forms of damages arising out of or relating to my participation in Martial Arts activities, including, but not limited to, losses caused by the negligence of the Released Parties. 3. WAIVER. I hereby forever knowingly waive and release all claims, damages, demands, and causes of action against the Released Parties for injuries, loss of life, and all other forms of damages arising out of or relating to my participation in Martial Arts activities, including, but not limited to, losses caused by the negligence of the Released Parties. I further waive and release any and all legal rights that may accrue to me, to my minor child, or to the minor child for whom I am legal guardian, as the result of any injury or damage that my minor child, the minor child for whom I am legal guardian, or I myself may suffer which in any way arise from or relate to Martial Arts activities. 4. ASSUMPTION OF RISK. I understand and acknowledge that Martial Arts activities have inherent dangers that no amount of care, caution, instruction or expertise can eliminate and I expressly and voluntarily assume all risk of death or personal injury or other forms of damages sustained while participating in Martial Arts activities whether or not caused by the negligence of the Released Parties. 5. COVENANT NOT TO SUE. I further agree that I will not sue or otherwise make a claim against the Released Parties for personal injury, death, damages or other losses sustained as a result of my participation in Martial Arts activities. Page 1 of 2

6. IDENTIFIICATION. I, as an adult participant or parent/guardian of a minor participant, also agree to indemnify and hold the Released Parties harmless, jointly and severally, from and against any and all claims, demands, judgments, and costs, including attorneys’ fees, of any nature whatsoever, including claims of negligence of a Released Party, arising out of a loss caused or suffered in connection of my participation or the participation of my child or ward in Martial Arts. 7. HOLD HARMLESS. I will take full responsibility for, and hold harmless the Released Parties for any injury, property damage, or death that I or my child or ward may suffer or inflict upon others or their property as a result of my engaging in Martial Arts activities. 8. SAFE OPERATION. I agree that if I operate any equipment while participating in Martial Arts, I will do so in a reasonable and safe manner so as not to endanger the lives of persons or property of any individual. If an any time I feel that anything is unsafe, I will immediately take all precautions to avoid the unsafe areas or activities and refuse to participate further. I have read and understand the above and acknowledge that the same constitutes a full release of liability and waiver of my legal rights and also constitutes a full assumption of liability by me of all risks arising out of or relating to my engaging in Martial Arts. I further represent that this Participation Agreement shall continue in full force and effect for so long as I engage in Martial Arts activities which are in any way connected to or with the Released Parties. I further represent that I am at least 18 years of age, and that I am either the participant named below or the parent or legal guardian of the minor child participant named below. I hereby execute this Participation Agreement on my own behalf and also on behalf of the minor child participant (if any) named below, and I hereby expressly recognize that this Participation Agreement is a contract pursuant to which I have released any and all claims against the Released Parties resulting from participation in Martial Arts activities including any claims by any of the undersigned arising from or related to the negligence of the Released Parties. I hereby further agree that this Participation Agreement shall be governed by the laws of the state of Arkansas law regardless of other conflict of law principles, and that if any portion of this document shall be deemed void or unenforceable, such portion shall be severable from this document, and the remaining terms of this document shall be given their full force and effect.

I HAVE READ THIS PARTICIPATION AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS AND THAT IT AFFECTS LEGAL RIGHTS I, OR A MINOR FOR WHOM I AM PARENT/LEGAL GUARDIAN, MIGHT OTHERWISE HAVE. I SIGN IT OF MY OWN FREE WILL AND AGREE TO BE BOUND BY IT.


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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