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131A Great Road Street, Bedford, MA 01730

Bernardo Faria Brazilian Jiu-Jitsu Academy Waiver

February 8, 2025

RELEASE, ACKNOWLEDGEMENT OF RISK AND WAIVER OF LIABILITY

In consideration of being allowed to participate in any way in the gym activities of the Bernardo Faria Academy described below, the adult participant named below agrees, or the parent(s) and/or legal guardian(s) of the minor participant (under 18 years of age) named below agree:

The Bernardo Faria Academy shall not assume responsibility or be held liable for any injury to person or damage or loss of property suffered by any member or any guest. I certify that I am familiar with the risks Inherent in participating in gym activities conducted in the Bernardo Faria Academy’s facilities. Further, I am aware of the risk of personal injury when undertaking such sports activities. Such risks could include partial or total disability, paralysis and even death. I understand that the Bernardo Faria Academy does not require participation in such activities, but I want to do so (or authorize the minor participant to do so) despite the possible dangers and risks and despite this release.

Therefore, in consideration of being permitted to become a member of the Bernardo Faria Academy, the participant voluntarily assumes all risks of personal injury, property damage, and/or other damages to the undersigned resulting from, or in any way associated with my entry within the Bernardo Faria Academy’s facilities and/or participation in any of the sport activities sponsored by the Bernardo Faria Academy.

Further, I hereby release the Bernardo Faria Academy and its officers, directors, owners, employees, instructors, trainers, volunteers and agents (collectively, “Releasees”) from every claim, demand, suit, liability, or damage of any kind or on account of any personal injury, property damage, or other damages, known or unknown, resulting from or in any way associated with my entry upon the Bernardo Faria Academy’s premises and participation in the said sports activities, even if caused by the action, inaction or negligence of Releasees (collectively, “Liabilities”), and I agree to defend, indemnify, and save Releasees harmless from and against any and all Liabilities. I agree that this release shall bind the members of my family and spouse, if I am alive, and my heirs, assigns and personal representative, if I am deceased.

I give permission, free of charge, with no promise, representation or expectation of compensation, to use any photos, pictures, media, likeness of myself for advertisements, instructional videos in any medium or matter, online training programs, or marketing materials to promote martial arts sports, martial arts or fitness.

I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the Commonwealth of Massachusetts and if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I represent and warrant that I have carefully read the forgoing release and waiver and understand the contents thereof and voluntarily sign this release as my own free act, thereby giving up substantial rights by signing it, agree to be bound by the release, and further agree that no oral Representations, statements or inducements apart from the foregoing written agreement have been made.

I CONFIRM THAT I HAVE CAREFULLY READ AND UNDERSTAND THIS RELEASE.


First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
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

Emergency contact #1

Phone:

Relationship to Minor:

Email
Parent/Guardian Consent: *If under 18 Parent or Guardian Signature in required* I, as the parent or legal guardian of the student of this general release I have completed this agreement for the purpose of enabling the student to participating in the activities offered and give my consent to allow the student to participate in classes, training and use of the training facilities. In the event of an injury or any medical emergency, I authorize any Instructor or Staff member of the Bernardo Faria Academy to procure medical attention to the member if the parent, guardian or emergency contact is unavailable.


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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Current Belt Rank or Experience Level*

Do you (or your child) have any health or medical conditions *
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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