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Cruz Control Brazlian Jiu-Jitsu
Teo Brazlian Jiu-Jitsu

STUDENT RELEASE FORM

RELEASE OF LIABILITY AND ASSUMPTION OF RISK -- COVID-19

Email: info@cruzcontroljiujitsu.com
Website: www.cruzcontroljiujitsu.com

TRAINING CENTER LOCATIONS

Renzo Gracie Woodland Park / Camal Judo
86 Lackawanna Ave
Suite 104
Woodland Park, NJ 07424
Tel: (201) 960-6584

Renzo Gracie Fort Lee / Skelley Judo
2175 Lemoine Avenue
Suite 201
Fort Lee, NJ 07024
Tel: (201) 450-9790

STUDENT RELEASE

I hereby represent the personal information contained herein is true and correct, and that it is hereby understood and agreed that in consideration of membership in the training centers owned or operated by Camal Judo, Teo BJJ, Skelley Judo, Renzo Gracie Woodland Park, Renzo Gracie Fort Lee and/or Cruz Control Jiu-Jitsu, neither Camal Judo, Teo BJJ, Skelley Judo, Renzo Gracie Woodland Park, Renzo Gracie Fort Lee and/or Cruz Control Jiu-Jitsu, or its instructors, agents, or servants shall in any way be liable to the student, his or her heirs, executors or administrators for any injury to person or damage to property, or redress in any form for any injuries, fatal or otherwise, caused to or sustained by the student because of accident, negligence or cause whatsoever. We recommend consulting your physician before attending your first class.

RELEASE OF LIABILITY AND ASSUMPTION OF RISK -- COVID-19

In consideration of being permitted to participate in any way (including observing classes) in judo, jiu-jitsu, self-defense, and other related activities conducted by Camal Judo, Teo BJJ, Skelley Judo, Renzo Gracie Woodland Park, Renzo Gracie Fort Lee and/or Cruz Control Jiu-Jitsu, and related events and activities of United States Judo, Inc. (USA Judo), I hereby:

  1. Confirm that I have not been diagnosed with SARS-CoV-2 (the virus that causes COVID-19 a.k.a. coronavirus), but if so, that the recommended self-quarantine period has expired.
  2. Confirm that I have not been advised or directed by a medical office, medical professional or government authority to self-quarantine or isolate myself from persons outside of my household, and if so, that any self-quarantine period has expired.
  3. Confirm that no person in my household has been diagnosed or exhibited symptoms of COVID-19 within the last 14 days.
  4. Confirm that, to the best of my knowledge, I have not been exposed within the last 14 days to any person who has contracted COVID-19.
  5. Understand that participation in judo, jiu-jitsu, self-defense, and other related activities involves close and direct contact with other persons.

I AM AWARE AND UNDERSTAND THAT MY PARTICIPATION IN JUDO, JIU-JITSU, SELF-DEFENSE, AND OTHER RELATED ACTIVITIES INVOLVES THE RISK OF EXPOSURE TO COVID-19, WHICH MAY RESULT IN SERIOUS ILLNESS AND/OR DEATH, AND SIGNIFICANT MONETARY LOSSES. I ACKNOWLEDGE THAT I AM VOLUNTARILY PARTICIPATING IN THE ACTIVITIES WITH KNOWLEDGE OF THE DANGER INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF ILLNESS, DEATH, OR MONETARY LOSSES.

I hereby release, waive, discharge and covenant not to sue Camal Judo, Teo BJJ, Skelley Judo, Renzo Gracie Woodland Park, Renzo Gracie Fort Lee and/or Cruz Control Jiu-Jitsu, Judo of New Jersey, Inc, together with their affiliated clubs, their respective administrators, directors, owners, agents, coaches, members, and other employees or volunteers of the organization, and if applicable, owners, lessors, and lessees of premises used to conduct judo, jiu-jitsu, self-defense and other related activities, all of whom are hereinafter referred to as a “releasee”, from any and all claims, demands, losses, or damages on account of illness, injury, including permanent disability and death, caused or alleged to be caused in whole or in part by the negligence of the releasee or otherwise to the fullest extent permitted by law.

I HAVE READ THE ABOVE WARNING, WAIVER AND RELEASE, UNDERSTAND THAT I GIVE UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND KNOWING THIS, SIGN IT VOLUNTARILY I AGREE TO PARTICIPATE KNOWING THE RISK AND CONDITIONS INVOLVED AND DO SO ENTIRELY OF MY OWN FREE WILL. I AFFIRM THAT I AM AT LEAST 18 YEARS OF AGE, OR, IF I AM UNDER 18 YEARS OF AGE, I HAVE OBTAINED THE REQUIRED CONSENT OF MY PARENT/GUARDIAN AS EVIDENCED BY THEIR SIGNATURE BELOW.

Today's Date: October 24, 2021

First Student's Name

First Name*

Last Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

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

First Name*

Last Name*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
How'd You Hear About Us

How'd You Hear About Us (Website/Referral/Word of Mouth/Etc.)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and, for myself, my heirs, assigns, successors and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to minor participant's involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications and the minor participant has acknowledged he understood them.
Parent or Guardian's Name

First Name*

Last Name*

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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