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Release and Waiver of Liability and Indemnity Agreement (Read Carefully Before Signing) Waiver

1.     Participation is voluntary: The participant has been advised by Rebellion Jiu-Jitsu LLC dba Rebellion Jiu-Jitsu (Rebellion Barbell, 206 South) and Bing 69 LLC dba Phantom Brazilian Jiu Jitsu (hereinafter REBELLION JIU-JITSU/PHANTOM BJJ) that participation in any and all activities is voluntary. Participant understands and agrees that, if at any time, participant feels anything to be unsafe, including but not limited to equipment, facilities and/or activities, participant will immediately take all precautions to avoid the unsafe area, equipment, and/or activity and refuse to participate further.

2.     Understand risks of participation: Participant fully understands and acknowledges that: (a) there are risks and dangers associated with participation in martial arts events/activities, fitness activities, facilities, programs, services and equipment which could result in bodily injury, partial and/or total disability, contraction of illness and/or disease, paralysis and death, (b) the social, physical, mental, and economic losses and/or damages, which could result from these risks and dangers described above, could be severe, (c) 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 parties named below, and (d) there may be other risks not known to us or are not reasonably foreseeable at this time.

3.     Acknowledge risks of participation: Participant hereby acknowledges that the activities are very dangerous and involve the risk of serious injury and/or death and/or property damage. Each of the undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures.

4.     Acceptance of responsibility/assumption of risk of participation: Participant accepts and assumes such risks and responsibility for the losses and/or damages following such injury, contracted illness or disease, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of REBELLION JIU-JITSU/PHANTOM BJJ its owners, agents or employees, or by intentional conduct of parties not an owner, agent, instructor, or employee of REBELLION JIU-JITSU/PHANTOM BJJ.

5.     Participant responsibilities: I certify that I am in good health and physical condition, and do not have any communicable illnesses, conditions, or diseases. I certify that I will not participate in any activities if 1 am not in good health and physical condition. It is my responsibility to be aware of the demands of the activity at all times. It is my responsibility to be adequately equipped and physically prepared. It is my responsibility to follow the instructions of the designated class leader. Skills taught in this program will not assure my safety in situations of self-defense. I am solely responsible for my own personal safety and the safety of others in the program.

6.     Release of liability/ covenant not to sue: Participant hereby releases, waives, discharges, and covenants not to sue REBELLION JIU-JITSU/PHANTOM BJJ, 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, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, from all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next to kin, for any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise.

7.     Release applies to all parties associated with REBELLION JIU-JITSU/PHANTOM BJJ: This release applies to all parties including REBELLION JIU-JITSU LLC dba Rebellion Jiu-Jitsu, Jaimeson Filer individually and his marital community, Zach Filer individually and his marital community, Bing 69 LLC dba Phantom Brazilian Jiu Jitsu, Ronald Crook individually and his marital community, any designated instructors, guest instructors, the owners and officers of these organizations, the instructors, and the owners of the property location.

8.     Release construed broadly: Each of the undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall notwithstanding continue in full legal force and effect. This release also applies to any dependents, parents, heirs, guardians, family, or any other party having the right to pursue any and all claims on the participant's behalf.

9.     Minor participation requirements: In consideration of being permitted to participate in any way with REBELLION JIU-JITSU/PHANTOM BJJ and/or being permitted to enter for any purpose any restricted area (herein defined as any area where admittance to the general public is prohibited), the parents) and/or legal guardian(s) of the minor participant named below agree: Prior to participating in the below martial arts activity or event, the Participant, parents) and/or legal guardian(s) will inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant will immediately advise the officials of such condition and refuse to participate.

10.   Parent must defend, indemnify, and hold harmless REBELLION JIU-JITSU/PHANTOM BJJ for minor: On behalf of the participant and individually, the undersigned parent(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releases, the parents(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them harmless.

11.   Release applies to family, heirs etc: This release applies to any claim the participant or any parent, guardian, family member, dependent, heir or any other party having the right to make a claim on behalf against REBELLION JIU-JITSU/PHANTOM BJJ, guest instructors and organizations, the owners of these organizations, the instructors, and any owners of the property location.     

12.   Only sanctioned use of skills: The participant understands that the skills taught at REBELLION JIU-JITSU/PHANTOM BJJ are to be used solely in accord with the law, that the participant has been explicitly instructed to not use the skills taught at REBELLION JIU-JITSU/PHANTOM BJJ outside of class with the exception of sanctioned tournaments or MMA events. I am solely responsible for my actions using the skills taught by REBELLION JIU-JITSU/PHANTOM BJJ and agree to defend and indemnify REBELLION JIU-JITSU/PHANTOM BJJ for any of my actions that result in claims against REBELLION JIU-JITSU/PHANTOM BJJ.

13.   Model photography/video release: Participants involved in any activities offered by Rebellion Jiu-Jitsu may be photographed or videotaped during training. I agree that REBELLION JIU-JITSU/PHANTOM BJJ may use my image, photo, likeness for any purpose, including but not limited to: REBELLION JIU-JITSU/PHANTOM BJJ /206 South websites, social media, promotions, instructional videos, and advertising material produced/or published by REBELLION JIU-JITSU/PHANTOM BJJ including the social media accounts of any designated instructors, guest instructors, the owners, and its members and their families.

14.   Release of personal property loss: Participant is responsible for their owner personal property and agree to release and hold harmless REBELLION JIU-JITSU/PHANTOM BJJ for any losses of personal property.

15.   REBELLION JIU-JITSU/PHANTOM BJJ Right to prohibit practice or participation: REBELLION JIU-JITSU/PHANTOM BJJ reserved the right to prohibit participation for any reason without providing a refund.

16.   Validity of release: If any portion of this agreement shall be held invalid, illegal, or unenforceable to any extent and for any reason by any Court of competent jurisdiction, the remainder of this agreement shall not be affected thereby and shall be enforceable to the full extent permitted by law.

17.   Participant medical coverage: By signing below, participant acknowledges that they carry personal medical insurance and/or participant understands that he/she is solely responsible for his or her own medical bills and any injury regardless of the cause.

18.   Cancellation Policy: By signing below, participant acknowledges that if they wish to cancel their membership, they will provide REBELLION JIU-JITSU/PHANTOM BJJ a Thirty day advance written notice. If you contract commitment has concluded, the request will be processed within 30 days. If you have a payment scheduled within the 30-day window, it will still be processed, and you will be entitled to continued membership through the period this fee covers. On 12-month contracts, if you can provide proof that you’ve moved 50 or more miles away we can cancel your account early. Canceling early for any other reason will result in being billed for the remaining months on your contract, and you will be entitled to continued membership through the period this fee covers. Paid in full options are non-refundable but your renewal date can be pushed out if you end up needing to miss 3 or more weeks of training. Cancellation must be made in writing via e-mail and on that date, the 30-day cancellation period will begin.


I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WTHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF WASHINGTON THAT THIS STATEMENT IS TRUE AND CORRECT.

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Participant'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*

Emergency Contact's Relation to Participant
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.


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