TRAINING CENTER LOCATION
Camal and Cruz
266 Union Blvd
Totowa, NJ 07512
Tel: (201) 960-6584
Student/Parent/Guardian 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 and Cruz, 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. Student/Parent/Guardian is aware that a consultation with a physician is recommended before attending a 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 and Cruz and related events and activities of United States Judo, Inc. (USA Judo), I hereby:
- 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.
- 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.
- Confirm that no person in my household has been diagnosed or exhibited symptoms of COVID-19 within the last 14 days.
- 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.
- 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 and Cruz, 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: May 28, 2022