Loading...

MGVJW LLC AND MGINACTION LLC

COVID-19 Waiver and Acknowledgment

TODAY'S DATE: July 25, 2021

COVID-19 Waiver and Acknowledgment


The novel coronavirus, COVID-19 (the virus), has been declared a worldwide pandemic by the World Health Organization.  COVID-19 is highly contagious and is spread easily from person-to-person. The federal, state and city governments have all responded with recommended guidelines concerning preferred forms of public interaction and personal contact including social distancing, wearing masks, and limiting the number of people permitted to congregate in any area.   

By reading and signing this document, in addition to waiving any liability Marcelo Garcia Jiu-Jitsu, MGVJW LLC, MGINACTION LLC may have regarding the virus, you are expressing acknowledging your responsibility to keep our community safe.    
 
Guided by the various government agencies, Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC,  has instituted certain measures to help limit the spread of COVID-19. Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC, does not represent that these measures will in all cases prevent the spread of the virus, nor does Marcelo Garcia Jiu-Jitsu represent that it has implemented all means and methods available to prohibit contact with and/or contracting of the virus. 


By signing below,  I acknowledge that COVID-19 is highly contagious and I voluntarily assume the risk for myself and for them, and expressly acknowledge that I/we may come in contact with the virus while on the Marcelo Garcia Jiu-Jitsu ,MGVJW LLC, MGINACTION LLC property. 


I understand that contracting COVID-19 may result in illness, disability and /or death, and/or may result in the spread of the virus to my household, community, and beyond.  I recognize and understand that exposure to the COVID-19 virus at Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC, may result from the actions, omissions, or negligence, carelessness, and recklessness of persons at Marcelo Garcia Jiu-Jitsu including but not limited to employees, members (and members’ guests). I, individually and as parent and natural guardian of my above-named child(ren) voluntarily assume the risks inherent in being on the property and the possibility of contracting COVID-19.  I accept any and all responsibility for injury, illness, liability, and any expense of any kind that I may incur in connection with attendance at Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC, by myself. I release, indemnify and hold harmless Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC,, Marcelo Garcia Jiu-Jitsu employees, agents, officers, governors, members, and representatives from any and all claims, liabilities, actions, damage and expenses arising out of any action stated or implied. I individually understand and agree that this release includes any claims based on the actions, omissions, or negligence, carelessness, and recklessness of the Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC, its employees, agents, officers, governors, members  and representatives, whether a COVID-19 infection occurs before, during or after in any visit to Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC.


In visiting Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC and using its facilities, and in interacting with other people at Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC, you are expressly acknowledging that you may be exposed to and contract Covid19.  Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC is making efforts to prevent that, but you are acknowledging that those efforts are not exhaustive and do not guarantee in any manner that you will not be exposed to and contract the virus.  Even with those risks, you are promising that you will personally take every effort to prevent the spread of the virus Marcelo Garcia Brazilian Jiu Jitsu, MGVJW LLC, MGINACTION LLC

First Students Name

First Name*

Last Name*

Phone*
First Students Date of Birth*
First Students Information

Current Brazilian Jiu-Jitsu experience

First Students Signature*
Second Students Name

First Name*

Last Name*
Second Students Date of Birth*
Second Students Information

Current Brazilian Jiu-Jitsu experience

Third Students Name

First Name*

Last Name*
Third Students Date of Birth*
Third Students Information

Current Brazilian Jiu-Jitsu experience

Fourth Students Name

First Name*

Last Name*
Fourth Students Date of Birth*
Fourth Students Information

Current Brazilian Jiu-Jitsu experience

Fifth Students Name

First Name*

Last Name*
Fifth Students Date of Birth*
Fifth Students Information

Current Brazilian Jiu-Jitsu experience

Sixth Students Name

First Name*

Last Name*
Sixth Students Date of Birth*
Sixth Students Information

Current Brazilian Jiu-Jitsu experience

Seventh Students Name

First Name*

Last Name*
Seventh Students Date of Birth*
Seventh Students Information

Current Brazilian Jiu-Jitsu experience

Eighth Students Name

First Name*

Last Name*
Eighth Students Date of Birth*
Eighth Students Information

Current Brazilian Jiu-Jitsu experience

Ninth Students Name

First Name*

Last Name*
Ninth Students Date of Birth*
Ninth Students Information

Current Brazilian Jiu-Jitsu experience

Tenth Students Name

First Name*

Last Name*
Tenth Students Date of Birth*
Tenth Students Information

Current Brazilian Jiu-Jitsu experience

Students 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 legal Guardian Email Address

Email*

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

Emergency Contact's 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.
Parent or legal Guardian Name

First Name*

Last Name*

Relationship*

Phone*
Parent or legal Guardian Date of Birth*
Parent or legal Guardian Information

Current Brazilian Jiu-Jitsu experience

Parent or legal Guardian 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!