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Ronin Brazilian Jiu Jitsu

and Fitness

(Ronin Brazilian Jiu Jitsu)

2 Park Street, Attleboro,

MA 02703

(774) 565-4357

Waiver and

Release of Liability

 

IN CONSIDERATION OF THE SERVICES OF RONIN BRAZILIAN JIU JITSU AND FITNESS (RONIN BJJ), THEIR AGENTS, VOLUNTEERS, PARTICIPANTS, EMPLOYEES, OWNERS, AND ALL ENTITIES ACTING ON THEIR BEHALF COLLECTIVELY REFERRED TO AS RONIN BJJ HEREAFTER, I HEREAFTER AGREE TO RELEASE AND DISCHARGE RONIN BJJ ON BEHALF OF MYSELF, MY CHILDREN, MY PARENTS, HEIRS, ASSIGNS AND ESTATE AS FOLLOWS:

A: I KNOW THE STUDY AND TRAINING OF MARTIAL ARTS LIKE JUDO, BRAZILIAN JIU JITSU, KICKBOXING, MUAY THAI, FITNESS ACTIVITIES, AND SELF-DEFENSE ENTAILS KNOWN UNANTICIPATED RISKS WHICH COULD RESULT IN PHYSICAL OR EMOTIONAL INJURY; PARALYSIS, DEATH, OR DAMAGE TO MYSELF, TO PROPERTY OR TO THIRD PARTIES. I UNDERSTAND THAT SUCH RISK SIMPLY CANNOT BE ELIMINATED; SOME OF THESE RISKS INCLUDE BUT ARE NOT LIMITED TO HEART ATTACK, BRUISES, BROKEN BONES, OR OTHER SERIOUS INJURY.

B: I AGREE AND PROMISE TO ACCEPT AND ASSUME ALL RISKS EXISTING IN THIS ACTIVITY. MY PARTICIPATION IS COMPLETELY VOLUNTARY AND I WANT TO PARTICIPATE DESPITE THE KNOWN AND UNKNOWN RISKS.

C: I RECOGNIZE THAT PARTICIPATION INCLUDES BODY CONTACT AND GRABBING OF VARIOUS BODY PARTS.

D. I HEREBY VOLUNTARILY RELEASE, FOREVER DISCHARGE, AND AGREE TO INDEMNIFY AND HOLD HARMLESS RONIN BJJ FROM ANY AND ALL CLAIMS, DEMANDS OR CAUSES OF ACTION, WHICH ARE IN ANY WAY CONNECTED TO MY PARTICIPATION IN THIS ACTIVITY OR USE OF EQUIPMENT, OR FACILITIES INCLUDE ANY SUCH CLAIMS, WHICH ALLEGE NEGLIGENT ACTS OR OMISSIONS OF RONIN BJJ.

E. SHOULD RONIN BJJ OR ANY ONE ACTING ON THEIR BEHALF BE REQUIRED TO INCUR ATTORNEY FEES AND COSTS TO ENFORCE THIS AGREEMENT I AGREE TO INDEMNIFY AND HOLD THEM HARMLESS FOR ALL SUCH FEES AND COSTS.

F. I CERTIFY THAT I HAVE ADEQUATE INSURANCE TO COVER ANY INJURY OR DAMAGE I MAY CAUSE OR SUFFER WHILE PARTICIPATING OR ELSE I AGREE TO BEAR THE COSTS OF SUCH PROBLEMS. I FURTHER CERTIFY I HAVE NO MEDICAL CONDITION, WHICH COULD INTERFERE WITH MY SAFETY OR PARTICIPATION IN SUCH ACTIVITY BY ANY SUCH CONDITION.

G. I HEREBY GRANT RONIN BJJ PERMISSION TO USE MY LIKENESS IN A PHOTOGRAPH, VIDEO, OR OTHER DIGITAL MEDIA IN ANY AND ALL OF ITS PUBLICATIONS, INCLUDING WEB-BASED PUBLICATIONS, WITHOUT PAYMENT OR OTHER CONSIDERATION. I UNDERSTAND AND AGREE THAT ALL PHOTOS WILL BECOME THE PROPERTY OF RONIN BJJ. I HEREBY IRREVOCABLY AUTHORIZE RONIN BJJ TO EDIT, ALTER, COPY, EXHIBIT, PUBLISH, OR DISTRIBUTE THESE PHOTOS FOR ANY LAWFUL PURPOSE. IN ADDITION, I WAIVE ANY RIGHT TO INSPECT OR APPROVE THE FINISHED PRODUCT WHEREIN MY LIKENESS APPEARS. ADDITIONALLY, I WAIVE ANY RIGHT TO ROYALTIES OR OTHER COMPENSATION ARISING OR RELATED TO THE USE OF THE PHOTO.

H. UPON SIGNING UP FOR CLASSES, I AGREE TO PROVIDE 60 DAYS WRITTEN NOTICE OF CANCELLATION

BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT IF ANYONE IS HURT OR PROPERTY IS DAMAGED, I MAY BE FOUND BY A COURT OF LAW TO HAVE WAIVED MY RIGHT TO MAINTAIN A LAWSUIT AGAINST RONIN BJJ AND ITS EMPLOYEES, AGENTS, VOLUNTEERS, PARTICIPANTS, OR ENTITIES ON THE BASIS OF ANY CLAIM FROM WHICH I HAVE RELEASED THEM HEREIN. I HAVE READ AND COMPLETELY UNDERSTAND THIS DOCUMENT AND I AGREE TO BE BOUND BY ITS TERMS.



First Students Name
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First Students Date of Birth*
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First Students Signature*
Second Students Name
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Students Date of Birth*
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Third Students Name
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Students Date of Birth*
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Fifth Students Name
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Sixth Students Name
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Seventh Students Name
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Students Date of Birth*
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Eighth Students Name
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Students Date of Birth*
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Ninth Students Name
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Phone*
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Students Date of Birth*
Date of Birth
Tenth Students Name
First Name*
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Phone*
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Students Date of Birth*
Date of Birth
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 Guardian's Email Address
Email*
Confirm Email*
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
Parent or Guardian's Driver's License / ID Card
Driver's License / ID Card Number*
Issuing State*
Insurance
Insurance Carrier
Insurance Policy Number
Activity
Participant will be taking part in: *
Boxing
Brazilian Jiu Jitsu
Group Fitness/Personal Training
Muay Thai/Kickboxing
Parkinson's Boxing Program
Sambo
Self-Defense Workshop
Wrestling
Occupation
Referred By
Please indicate if you have any communicable illness or disease.
Yes
No
Please answer the following required questions.
Have you ever been convicted of or charged with a sex crime? *
Yes
No
Have you ever been charged with a crime against a minor, harassment, a violent crime, or convicted of a felony? *
Yes
No
If you answered yes, please explain.
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*
Last Name*
Relationship*
Phone*
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Parent or Guardian's Date of Birth*
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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