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 Waiver of Liability at Impact Jiu Jitsu Mcminnville LLC
(and various programs associated and taught by Impact Jiu Jitsu Mcminnville LLC)

I understand that the instructors, senior students, or others may have some skills in first aid, CPR, and, at their discretion, I authorize them to use those skills and techniques to assist in any circumstance in which they judge their skills would be necessary or helpful.

ADVISORY OF RIGHTS AND RESPONSIBILITIES

Safety is not the sole responsibility of instructors and staff. Everyone in class is responsible for their own safety and the safety of those around them.

 

All students have the right and responsibility to excuse themselves from any exercise they believe will be harmful to them. All students must evaluate each situation in the context of their skill and current physical condition,and conduct each drill in a manner that is safe. If an instructor gives an instruction that is unsafe for the student, it is the student’s responsibility to inform the instructor that the skill may be unsafe. The instructor will routinely excuse the student from unsafe exercises and drills. The instructor may ask for an explanation, and the student is expected to provide one.

All students have a responsibility to train and conduct themselves in a manner that helps all students and instructors remain safe. Students must give those who are training enough room to avoid interfering with, and avoid being accidentally struck by, someone else practicing, which is especially important when others are practicing with weapons.

In the event of an injury, students have the right and responsibility to evaluate the extent of harm, stopping what they are doing even if it includes a partner, and determining that it is safe to continue. Unless a student is certain that further practice will not create or worsen a problem, all students are encouraged to stop what they are doing and inform an instructor. In the event of a serious injury, or appearance of a serious injury, all students, instructors, staff, and visitors, notably parents, have the right to call a stop to a particular training exercise.

If a student notes an unsafe training situation which may include a student performing a skill incorrectly, a student not being careful about others, a defect in a piece of training equipment, a potentially dangerous obstacle or condition on the floor, or anything else that may cause or lead to harm of students, instructors, staff, visitors, or guests, then the student is expected to correct the situation if within his ability, or notify an instructor or staff member immediately. If something is simple to correct, such as picking up equipment left on the floor, the student should correct the situation. If the situation may require the authority of the instructor of staff, or if it is not a simple matter, then an instructor or staff member should be notified immediately.

ASSUMPTION OF RESPONSIBILITIES AND RISK

Martial arts/performance training/fitness training are potentially dangerous activities. Bumps, bruises, scrapes, scratches, and soreness are commonplace, and most students will encounter this sort of minor injury from time to time in their training. More serious injuries are possible, including sprains, strains, twists, cramps, and injuries of similar magnitude, and students can expect to encounter these injuries infrequently. The possibility of more serious injury exists, including fractured bones, broken bones, torn ligaments, though not all students encounter such serious injuries. There remains, despite safety precautions, the remote possibility of crippling or death, though this is certainly not expected in any martial arts/performance training/fitness class. The possibility of contracting COVID-19 is real, and member agrees to hold academy, owners, instructors, staff, students, guests, visitors, Landlords, management companies, and any and all parties harmless of any liability arising from COVID-19.

I understand the above statement of risk, and I understand the rights and responsibilities of students. I assume responsibility for my own safety (or the safety of my child), understanding and accepting the risks involved with martial arts/performance training/fitness training. Even if the instructor has informed me that no serious injuries have ever happened in this facility or with any of the instructors, I understand that this does not mean that there is no possibility of harm. By assuming this risk, I completely absolve all owners, instructors, staff, students, guests, visitors, landlords, management companies, and any and all other parties of liability for my harm, unless intentionally caused in criminal conduct.

NOTICE AND CONSENT TO INSTRUCTORS

These martial arts/performance training/fitness classes seek to make use of highly trained, professional instructors, with expertise and experience both in the arts/exercises we teach and in teaching. The head instructor or any other qualified instructor may teach classes. Should an instructor be unavailable for a given class, a junior instructor, senior student, or guest instructor may teach. The choice of the instructor is left to the discretion of the head instructor.

I understand that I may not always have the instructor I desire, but I shall seek to learn from whoever is teaching, to show the respect to whomever is teaching, and to conduct myself in accordance with the etiquette established at this class. I

understand that I have the responsibility for my own safety without regard to who is teaching the class. I specifically consent to any instructor that the head instructor feels is sufficiently qualified by any standards he sets to teach the class. I specifically understand and agree that the full force of this document applies no matter who is teaching. 

NOTICE OF PHYSICAL CONTACT

Complete martial arts training involves a wide variety of skills. While practicing these skills, students may have contact with any portion of the body. The groin may be the target of kicks, strikes, and grabs. The chest, buttocks, groin, or any part of the body may be contacted by any part of the training partner’s body during training by martial arts techniques, or incidentally contacted while performing a martial arts technique targeting another portion of the body.

When male and female students train together, or when adult and minor students train together, and in any other training combination, the purpose and intent of the class, instructors, and staff is to provide an environment for all students to learn and practice martial arts and self-defense. Students are expected to conduct themselves appropriately at all times to ensure the best training results for everyone.

Should any student feel a training partner is engaging in contact beyond the scope of training, or a training partner is taking undue and unacceptable advantage of training contact, or if a student is made uncomfortable by any training exercise or partner, then that student has the right to withdraw from the exercise or drill. If the conduct of the training partner appears inappropriate, the student should inform an instructor privately. If the conduct of the training partner or any training partner appears criminal, then an instructor should be informed and the authorities may be notified either by the student or the instructor, or both.

CONSENT TO PHYSICAL CONTACT

I understand the nature of physical contact in martial arts training, and I understand that I have the right to immediately withdraw from any exercise or drill in which the conduct of any party seems beyond the scope of training or makes me uncomfortable. I agree to abide by school etiquette in all matters pertaining to training, and I shall not in any way conduct myself inappropriately or take inappropriate advantage of the contact martial arts training allows.

ADVISORY OF MEDICAL EXAMINATION AND PHYSICIAN ADVICE

Because martial arts/performance training/fitness training are physically-based, athletic activities, participants must be in reasonably good health and physical condition. Those who are not in reasonably good health and physical condition due to age, illness, disability, infirmity, or any other reason, should not participate in such activity. Before undertaking such an activity, a student (or parent of a student) is advised to obtain a physical examination by a qualified physician and to seek a physician’s advice regarding whether or not the student should participate in such activity. If a student suffers from any type of ongoing or recurrent medical problem or physical limitation, it is essential that the student seek the advice of a physician before engaging in martial arts/performance training/fitness training.

I understand the above statements particularly that I should obtain a physical examination and physician’s advice as to whether or not I should engage in martial arts/performance training/fitness training. If I am a parent of a minor child enrolling in the class, I understand that my child should receive a physical examination and physician’s advice as to whether or not my child should engage in martial arts/performance training/fitness training. I understand and agree that I assume any and all risks of any injury and harm that may result from my failure to both obtain a physical examination and a physician’s advice for myself (or for my child if a parent) before I (or my child if a parent) undertakes martial

arts/performance training/fitness training. Further, I agree to completely absolve all owners, instructors, staff, students, visitors, guests, landlords, management companies, and any other parties for any injury or harm I (or my child if a parent) may receive as a result of my failure to obtain a physical examination and physician’s advice for myself (or for my child if a parent).

By participating in martial arts/performance training/fitness training, I am certifying that I am in reasonably good health and physical condition and am capable of taking part in such activity, regardless of whether or not I have received a physical examination or sought the advice of a physician. If I am a parent of a child participating in martial arts/performance training/fitness training, I am certifying that my child is in reasonably good health and physical condition and is capable of taking part in such activity, regardless of whether or not my child has received a physical examination or sought the advice of a physician.

 

ACADEMY POLICIES

The Enrollee irrevocably authorizes the Academy, its successors and assignees, and those acting under its authority, to copy, use, and/or publish, for art, advertising, trade, or any other lawful purpose whatsoever, photographic portraits, pictures, digital images, and/or videos in which the Enrollee may be included in whole or in part.

Sauna, Cold Plunge, and gym area are available for use to any member ages 16 or older ONLY. Use of these amenities is solely at member’s discretion. Minors ages 16 and 17 MUST be accompanied by a parent/guardian at all times in the cold plunge and sauna rooms.


Date: November 19, 2024

First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Information

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

First Student's Signature*
Second Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Third Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Fourth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Fifth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Sixth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Seventh Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Eighth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Ninth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Tenth Student's Name

First Name*

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

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact Information

Emergency Contact Name *

Relationship to Student *

Phone 1 *
Parent Guardian Information (if student is under age 18)

Parent 1 (if student is under age 18)

Home Phone

Cell Phone

Parent 2 (if student is under age 18)

Home Phone

Cell Phone
Applicable only to Parents Enrolling Minor Child: I agree not to bring any claim or suit against the owners, instructors, staff, guests, students, landlord, or any other parties on behalf of my child for any injury or harm sustained by any event short of a criminal act, and then only the criminal shall be the subject of such a claim. I further agree that I will not cause to be brought, nor encourage, a claim or suit. I also agree not to cooperate in the bringing of such a suit or claim except insofar as I may be legally required to do so. Finally, I shall indemnify the owners, instructors, staff, guests, students, and any and all additional defendants covered by this agreement for all judgments, costs, attorney fees, and other expenses incurred as a result of a breach of this agreement.


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*
Parent or Guardian's Information

AUTHORITY TO TREAT

I, the undersigned, give the instructors, staff, and responsible adults the power to authorize medical or other treatment of the person named above under "Student Name," subject to the limitations listed below, if any. If I am not the person so named, I am the parent, guardian, or adult responsible for the person named, and I have the legal right to grant this power. Treatment may be made without regard to whether I or any other parent, guardian, or adult responsible has been contacted or has consented to the specific treatment, provided it does not conflict with the limitations outlined below. This authority begins on the date signed and continues indefinitely.


Limitations to Treatment: *

Information of Medical Significance: *

By giving my authorization, I assume responsibilities for all decisions made, provided they are reasonable decisions under

the circumstances  based upon the knowledge and understanding of the person making the decisions, and I trust their

judgment and offer the benefit of the doubt to them in any claim or legal proceeding. This presumption may only be overcome by clear and convincing evidence that they acted with malice or willful gross negligence, and, if so, they may still be liable.

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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