Loading...

Student Waiver

I, have enrolled in the personalized health, fitness and martial arts program offered through Sion Brazilian JiuJitsu. I recognize that the program may involve strenuous physical activity including, but not limited to, muscle strength and endurance training, cardiovascular conditioning and training, and other various fitness activities. I hereby affirm that I am in good physical condition and do not suffer from any known disability or condition which would prevent or limit my participation in this exercise program. I acknowledge that my enrollment and subsequent participation in purely voluntary and in no way mandated by Sion Brazilian Jiujitsu

In consideration of my participation in this program, I, hereby release Sion Brazilian Jiujitsu and its agents from any claims, demands, and causes of action as a result of my voluntary participation and enrollment. I fully understand that I may injure myself as a result of my enrollment and subsequent participation in this program and I, hereby release Sion Brazilian Jiujitsu and its agents from any liability now or in the future for conditions that I may obtain. These conditions may include, but are not limited to, heart attacks, muscle strains, muscle pulls, muscle tears, broken bones, shin splints, heat prostration, injuries to knees, injuries to back, injuries to foot, or any other illness or soreness that I may incur, including death

I HEREBY AFFIRM THAT I HAVE READ AND FULLY UNDERSTAND THE ABOVE STATEMENTS.

TODAY'S DATE: November 21, 2024

First Student's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
Tenth Student's Date of Birth*
Student'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*

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*

Relationship*

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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!