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WAIVER / RELEASE / ASSUMPTION OF RISK

PLEASE READ CAREFULLY THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS

I understand and have had explained to me that the martial art known as “Gracie Jiu-Jitsu” is taught using precautions to avoid any injuries. However, participation in the Gracie Jiu-Jitsu classes carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks range from minor injuries such as scratches, bruises, and sprains, to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, to catastrophic injuries including paralysis and death. Furthermore, I understand the practice of Gracie Jiu-Jitsu presents a risk of skin infections, communicable diseases, bacteria(s) and viruses, including, but not limited to, the coronavirus.

I understand and have had explained to me that, along with the possibility of personal injury, injury to property is also possible, such as, but not limited to, possible loss of wages and the ability to earn such wages. With full knowledge of the aforementioned dangers, both to my person and to my property (current and future), and after having these dangers fully explained to myself and/or to my legal guardian (Legal Guardian), I nevertheless desire to participate in Gracie Jiu-Jitsu training and activities.

I hereby certify and declare that I will release and forever hold free and discharge from any liability Gracie Global LLC, d.b.a. Gracie University, DAF CO, and each of their owners, agents, stockholders, directors, officers, employees and representatives of and from all claims, demands, rights and causes of action of any nature whatsoever which may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or other loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from my participation in Gracie Jiu-Jitsu, their persons and entities mentioned above, including and not limited to any negligence on the part of Gracie University, their owners, agents stockholders, directors, officers, employees, volunteers representatives.

I understand that Gracie University crosschecks all of its students with the national sex offender database (NSOPW.gov) for the safety of its students. I understand that Gracie University reserves the right to refuse service to any individual who has been convicted of a sex crime.

Further, knowing and understanding these risks, nevertheless I hereby agree to voluntarily assume these risks and to release and hold harmless all the persons or entities mentioned above whom might otherwise be liable to me for damages. It is further understood that this waiver, release and assumption of risk is forever binding on my heirs, assigns, executors, administrators and representatives. I also understand and acknowledge that I have and will maintain appropriate medical insurance during classes/training.

I am also aware that for purposes of safety, security and quality control there are surveillance cameras mounted throughout Gracie Jiu-Jitsu Keego Harbor. Furthermore, I understand and acknowledge that often times video recording or photographs may be taken of me during classes/training. I hereby grant Gracie Global LLC, d.b.a. Gracie University and DAF CO, the unlimited use of my likeness in any format photo, video, or other, for promotional advertisement or commercial use in any format known or yet to be developed in perpetuity, and I forfeit any form of payment. It is further understood that I will not video record or photograph any classes/training without prior permission from Gracie University.

My signature on this document is evidence that I know and understand and have had this document explained to me, that I fully understand the dangers that are inherent in this martial art and that I voluntarily certify that I will not hold Gracie Global LLC, d.b.a. Gracie University, DAF CO, Rener Gracie, Ryron Gracie, the Gracie family, their owners, agents, staff, volunteers, and/or assigns, responsible for any injury whether as a result of training or not, including, but not limited to, any loss of personal property.

(Guardian Signature required if student is less than 18 years old)

Date: October 17, 2025



First Participant's Name
First Name*
Last Name*
First Participant's Date of Birth*
Date of Birth
First Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Second Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
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*
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*
Phone*
Parent or Guardian's Date of Birth*
Date of Birth
Parent or Guardian's Information
PRONOUNS
Cell Phone: *
Home Phone:
Height:
Weight:
Marital Status:
Occupation:
Employer/School Name:
Special Medical Concerns:
How did you hear about us:
Do you have and account on GracieUniversity.com*
No
Yes
Referring Student Name:
Are they a student at this location:*
No
Yes
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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