Loading...

Release and Waiver of Liability and Indemnity Agreement

(Read carefully before signing.)

In consideration of being permitted to participate in any way in the Connection Rio Jiu Jitsu Academy Inc.'s martial arts program and/or events, I/WE acknowledge, understand, and agree to the following (if signing for a minor participant as the legal guardian or parent, you are acknowledging, understanding and agreeing the following for the minor participant(s)):

Brazilian Jiu Jitsu, Judo, Thai boxing, Muay Thai, Boxing, Mixed Martial Arts, Self Defense, Yoga, and other forms of martial arts and fitness training (collectively "martial arts") are strenuous activities involving physical contact and may also involve the practice of techniques designed to subdue and control an opponent or another individual. I/WE understand that it is advisable that I/WE have a medical examination by a qualified physician before participating in martial arts or any other physical activity. I/We represent and warrant that I/WE am/are fit to participate in strenuous physical activities such as martial arts and have no physical disabilities affecting or limiting my and/or my child(ren)'s ability to do so.

No representation or warranties upon which I/WE have relied have been made to me and/or my child(ren) by any agent, owner, instructor or representative of or anyone associated with Connection Rio Jiu Jitsu Academy, Inc. also referred to in this agreement as the “Company” (including all parties doing business under the trade name Connection Rio Jiu Jitsu Academy, Inc., Connection Rio Jiu Jitsu Academy, LLC) or the “Company” or Dennis Asche, or any of their respective owners, shareholders, officers, directors, instructors, employees, members, managers, affiliates, agents, successors or assigns (collectively the “Company”) regarding the safety or outcome of the practice of martial arts or any other related physical activity.

I/WE recognize, accept and assume all risk of injury associated with practicing, participating in, traveling to or returning from any practice, class, seminar, lesson, competition or athletic event held by, associated with, or sponsored by the Company or any other organization. I/WE fully understand, acknowledge, and accept there are risks and dangers associated with participation in martial arts, fitness programs, events, and activities which could result in bodily injury, partial and/or disability, paralysis, and death. The social and economical losses and/or damages, which could result from these risks and dangers could be severe. These risks and dangers may be caused by the action, inaction, or negligence of the participant or the action, inaction, or negligence of others, including, but not limited to, the Company. I/WE recognize, accept, and assume such risks and responsibility for the losses and/or damages following any injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of the Company. Without limiting the foregoing, I/WE ASSUME ALL RISKS KNOWN OR UNKNOWN ASSOCIATED WITH PRACTICING ANY MARTIAL ARTS AND/OR OTHER PHYSICAL ACTIVITY OR EVENTS THROUGH OR ASSOCIATED WITH "THE COMPANY". I/WE ASSUME ALL RISKS KNOWN OR UNKNOWN WITH PARTICIPATING IN ANY MARTIAL ARTS SEMINAR OR COMPETITION BY, IN ASSOCIATION WITH OR REPRESENTING “THE COMPANY”.

On behalf of myself OR my minor(s), my successors or assigns, heirs, next of kin, personal representatives, and all persons claiming by, through, or under me, I/WE hereby fully and forever release, waive, relinquish, and discharge Connection Rio Jiu-Jitsu Academy, Inc., Connection Rio Jiu-Jitsu Academy, LLC., Dennis Asche, "the Company" and its owners, instructors, subsidiaries, affiliates and all past and present employees, officers, directors, shareholders, managers, members, agents, nominees, attorneys, successors and assigns (collectively the “Company Parties”), the martial arts facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the martial arts event or program or fitness programs, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activites regarding the martial arts facility or events held at such facitlity and each of them, their directors, officers, agents, employees from any and all claims, losses, liabilities, or demands of any nature whatsoever in law or in equity, for injury or death to myself or my child(ren) regardless of whether arising during or after my and/or my child(ren)'s membership or participation in the activities of the Company when directly or indirectly arising out of or resulting from any instruction, consultant and others who give recommendations or directions or instructions, training, practice, class, seminar, lesson, competition, altercation, or event of the Company, including, without limitation, traveling to, participating in, or returning from any such event. I/We hold harmless, defend and indemnify the Company, the Company Parties from and against any and all claims, losses, liabilities, or demands (including, without limitation, attorney’s fees) regardless of whether arising before, during or after my or my child(ren)'s membership or participation in activities of the Company, when directly or indirectly arising out of or resulting from my or my child(ren)'s acts or omissions in connection with the practice, instruction or use of or participation in the martial arts or the activities of the Company. I/We understand and agree that my or my child(ren)'s participation in any classes, lessons, practice, training, sparring, competitions or events held or sponsored by the Company is expressly conditioned upon my and/or my child(ren)'s agreement to the foregoing terms and conditions.

I/We hereby acknowledge and understand that martial arts training is a physical activity and learning self-defense skills involves physical contact. I/We hereby acknowledge and understand that martial arts is an on going learning process and development of skill and body / muscle memory take time to develop and I/We hold harmless, defend and indemnify the Company, the Company Parties, and any third party associated with the Company from and against any and all claims, losses, liabilities, or demands (including, without limitation, attorney’s fees) regardless of whether arising before, during or after my or my child(ren)'s membership or participation in activities of the Company, when directly or indirectly arising out of or resulting from my or my childe(ren)'s acts or omissions in connection with any altercation, competition, or training involving me or my child(ren) whether inside or outside of the training facility of the Company. I/We hereby agree and understand that Dennis Asche, the Company, the Company Parties, or any third party associated with the Company have not made any claim or promise to my or my child(ren)'s ability to competently execute techniques and or skills taught to me or my child(ren) in class, training, sparring, live setting, competition, or any form of altercation that may take place inside or outside of the training facility provided by the Company. Connection Rio Jiu Jitsu Academy, Inc, Dennis Asche, the Company and its shareholders, owners, staff, students, members, past or present employees, or any third party associated with the Company are not to be held liable or responsible for any risks and / or injuries that may occur as a result of training in martial arts, executing any techniques or training I/We have been taught or the result occuring from any such execution in training, class, sparring, live setting, competition, or altercation inside or outside of the training facility of the Company. I/We understand and agree that this Release and Indemnity, among other things, releases the Company from responsibility for my and/or my child(ren)'s injuries (both past and present injuries), any medical treatment, advice, recommendation, or practice received in connection with any injury that may have resulted before, during, or after my participation in any event, training, class, sparring, seminar, competition, associated with or provided with the Company, its staff, members, students, or outside medical advisors or death and makes me and/or my child(ren) responsible for injuries to or death of there caused by me or my chil(ren).

I/We agree that my and/or my child(ren)'s attendance and participation at Connection Rio Jiu Jitsu Academy, Inc. may be photographed, filmed, or taped, and used by Connection Rio Jiu Jitsu Academy, Inc. 'The Company' and thereby waive any rights or compensation thereof. I/We hereby authorize Dennis Asche and Connection Rio Jiu Jitsu Academy, Inc, 'The Company' including any owner, member, officer, director, shareholder, staff, student, or any third party associated with Dennis Asche and Connection Rio Jiu Jitsu Academy, Inc. to publishing media and images such as but not limited to, photography, recorded video, and recorded audio taken of me and/or my child(ren) on and my and/or my child(ren)'s name and likeness, for use on the Company website, online social media channels and pages, and other video-based content and marketing materials, as well as other Company’s publications, and any third party publications and online social media channels. I/We further acknowledge that my and/or my child(ren)'s participation is voluntary and that I/We will not receive financial compensation of any type associated with the taking or publication of any said media nor will I/We have rights of ownership or royalties whatsoever. I/We hereby release Dennis Asche, the Company, the Company third parties, its members, shareholders, owners, contractors, and any third parties involved in the creation or publication of all media content, including photography, recorded audio, recorded video, and marketing materials from liability for any claims by me and/or my child(ren) or any third party or family in connection with my participation.

Academy Etiquette / Code of Conduct:

  • Bow on and off the mat when entering the training area. 
  • Leave your ego at the door.
  • Line up by belt rank before and after class facing the instructor with highest ranking member on your left hand side.
  • No poor sportsmanship or temper tantrums. No swearing or yelling while on the mat. 
  • Mouth guards are recommended. Should the athlete choose not to wear a mouthguard, the athlete will be responsible for any and all damages to their teeth, mouth and face during their participation.
  • Respect your training partners at all times. Any disagreements, please bring to the attention of the instructor. 
  • Keep the mats clean, always clean up after yourself and / or your child(ren). This includes but is not limited to finger tape, water bottles, bandaids, snacks in the waiting area, etc.
  • If you bleed or vomit during class, clean yourself and all surrounding areas affected. (floor, sink, trash bins, wall, etc. ) 
  • All jewelry, including body piercings, and any type of metal, buttons, zippers, etc. are prohibited from being worn on the mat. 
  • No filming in class of any technique, drills, or sparring. No exceptions. 
  • No cell phone use during class. Phones are to be left outside of the training area. Please silence phones left in the dressing room.
  • Any form of bullying will not be tolerated. 
  • Follow the guidelines and requirements of the classes you are attending. Please reference table of contents in the CRA Student Handbook.
  • Punctual attendance is crucial. Students who are late should notify the instructor prior to class. If you show up late, you must ask permission to join a structured class. *This rule does not apply to open mat".
  • Follow the structured class as it is taught. For example, during entries and technique, drill the specific technique instructed by the instructor unless specifically asked to do so. Do not drill your own techniques or entries during this time. 
  • Take all personal items home with you when you leave the academy. 
  • We encourage students to ask questions, but ask questions at an appropriate time. Do not interrupt the instructor during instruction of a technique.
  • All members of the academy are considered team mates. There is to be no coaching / teaching during class unless specifically asked by an instructor to do so. 
  • We encourage and appreciate our students to represent CRA whenever possible. If you choose to represent the academy, we ask you to do so in a professional manner at all times and not one that would cause negative exposure to the academy or its members. 
  • Everyone is required to wear a CRA patch during class and representing the academy during competition.

Academy Hygiene Practices:

  • Shoes are to be worn in the bathroom at all times, never on the mat or in the dressing room.
  • Wash hands after the bathroom, and any time cleaning up any type of bodily fluids during class. 
  • Wash your gi and training apparel after every class. Wash your belt.
  • Rash guards, shirts (required for No-Gi / striking), kimono tops (gi classes) and underwear must be worn on the mat.
  • Toe nails and finger nails are to be kept short and clean during class. It is important you do not cut or scratch your training partners.
  • Wash your feet in the cleaning station before stepping on the mat. 
  • All open wounds / burns must be covered where they will not leak during training at all times. 
  • If you have ring worm, staph, any type of skin disease, or any type of virus or communicable illness, you are to observe only and not train in class until treatment is complete and symptoms are dissolved. 

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization (WHO). COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. 

Connection Rio Jiu-Jitsu Academy, Inc. ("Connection Rio BJJ") ("the Company") has put in place preventative measure to reduce the spread of COVID-19; however, Connection Rio BJJ cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending Connection Rio BJJ could increase your risk and your child(ren)'s of contracting COVID-19. 

Upon Being able to participate in Connection Rio BJJ's martial arts and fitness programs, I/We confirm the following:

I/We have had no symptoms of COVID-19 within the last 14 days nor have I/We have any known contacts with anyone testing positive for COVID-19 within the past 14 days.  

Should I/We find myself/ourselves exposed to COVID-19 or have any of the following symptoms, I agree to quarantine myself from the academy so as not to spread COVID-19 to other members. Symptoms include but are not limited to the following: 

  • Fever
  • Cough
  • Shortness of breath or difficulty breathing
  • Chills
  • Repeated shaking with chills
  • Muscle pain
  • Headache
  • Sore throat
  • New loss of tatse or smell
  • Cold / Flu like symptoms

By signing this agreement, I/We acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren) and I may be exposed to or infected by COVID-19 by attending any martial arts or fitness programs offered at Connection Rio BJJ and that such exposure or infection may result in personal injurty, illness, permanent disability, and death. I/We understand that the risk of becoming exposed to or infected by COVID-19 at Connection Rio BJJ may result from the actions, omissions or negligence of myself and others, including, but not limited to, Connection Rio BJJ employees, owners, volunteers, instructors, members, program participants, and their families.

I/We agree that as a student or Parent(s)/Guardian(s) of a student, I have the responsibility to immediately report a COVID-19 infection or suspected COVID-19 infection to Connection Rio Jiu-Jitsu Academy, Inc ("Connection Rio BJJ"). I/We voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)'s attendance at Connection Rio BJJ or participation in Connection Rio BJJ Programming ("claims"). On my behalf, and on behalf of my child(ren), I/We hereby release, covenant not to sue, discharge, and hold harmless Connection Rio BJJ, its owners, employees, agents, instructors, members, program participants, owners, and representative, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relation thereto. I/We understand and agree that this release includes any claims based on the actions, omissions, or negligence of Connection Rio BJJ, its employees, agents, instructors, members, program participants, owners, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any of Connection Rio BJJ's martial arts or fitness programs. 

 

First Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
First Athlete's Date of Birth*
First Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
First Athlete's Signature*
Second Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Second Athlete's Date of Birth*
Second Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Third Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Third Athlete's Date of Birth*
Third Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Fourth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Fourth Athlete's Date of Birth*
Fourth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Fifth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Fifth Athlete's Date of Birth*
Fifth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Sixth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Sixth Athlete's Date of Birth*
Sixth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Seventh Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Seventh Athlete's Date of Birth*
Seventh Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Eighth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Eighth Athlete's Date of Birth*
Eighth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Ninth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Ninth Athlete's Date of Birth*
Ninth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Tenth Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
Tenth Athlete's Date of Birth*
Tenth Athlete's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
Athlete's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*
Check to receive information, news, and discounts by e-mail.
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
Preferred Choice for Updates
Click to customize pull down*
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Training Experience

List Current or Previous Training Facility / Academy *

How Long Have You Been Training? *
Current Belt Rank*
White
Blue
Purple
Brown
Black
Grey
Yellow
Orange
Green

How Did You Hear About Us? *
Have you ever been convicted of a felony?*
No
Yes

If you have been convicted of a felony, please describe conviction below:
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!