Impact MAC Liability Waiver

Waiver of Liability at Impact Jiu Jitsu McMinnville LLC

IMPORTANT: THIS IS A LEGAL DOCUMENT. PLEASE READ CAREFULLY BEFORE SIGNING.

In consideration for being permitted to participate in Brazilian Jiu Jitsu, martial arts training, fitness classes, open mat sessions, competitions, and other related activities (collectively referred to as "Activities") at or through Impact Jiu Jitsu McMinnville (“Facility”), I hereby agree to the following waiver and release of liability:

1. Assumption of Risk

I understand that participation in Brazilian Jiu Jitsu and related activities involves physical contact, intense physical exertion, and carries inherent risks of injury, including but not limited to bruises, sprains, strains, fractures, concussion, permanent disability, and even death. These risks may arise from my own actions or inactions, the actions or inactions of others, the conditions of the Facility, or the nature of the sport itself. I fully understand and knowingly assume all such risks, whether known or unknown.

2. Waiver and Release

I, on behalf of myself, my heirs, executors, administrators, personal representatives, and assigns, hereby waive, release, and discharge Impact Jiu Jitsu McMinnville, its owners, instructors, coaches, staff, volunteers, affiliates, successors, and assigns (collectively, the “Released Parties”) from any and all claims, demands, liabilities, causes of action, costs, or expenses (including attorney’s fees), arising out of or related to any loss, damage, injury, or death I may sustain while participating in the Activities or while present at the Facility, regardless of whether caused by the negligence of the Released Parties or otherwise.

3. Medical Fitness and Authorization

I affirm that I am in good health and physically capable of participating in the Activities. I understand that it is my responsibility to consult with a physician prior to beginning any exercise or martial arts program. I authorize the Facility and its staff to provide or seek emergency medical care for me in the event of injury or illness. I understand and agree that I am solely responsible for all costs associated with such care.

4. Use of Likeness

I grant permission to Impact Jiu Jitsu McMinnville to use photographs, video recordings, or any likeness of me for promotional purposes, including on social media, websites, and printed materials, without compensation. I waive any rights of privacy or publicity I may have in that content.

5. Rules and Conduct

I agree to abide by all Facility rules, policies, and instructions provided by staff. I understand that failure to do so may result in my removal from the premises or termination of my participation without refund.

6. COVID-19 and Communicable Diseases

I understand that participation in group activities carries the risk of exposure to COVID-19 and other communicable diseases. I voluntarily assume all risks related to such exposure and release the Facility and the Released Parties from any and all liability resulting from such exposure.

7. Minors

If I am signing this waiver on behalf of a minor (under 18), I certify that I am the legal parent or guardian of the minor participant and agree to be bound by the terms of this waiver on their behalf.

Type Initials

Draw Initials

Initial

Date: October 21, 2025

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Adult Minor(s)
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First Student's Name

First Name*

Last Name*

Phone*

First Student's Date of Birth*

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.

Information of Medical Significance (allergies, medical diagnoses, etc.): *

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*

Type Signature

Draw Signature

Click to Sign

Second Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Second Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Third Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Third Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Fourth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Fourth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Fifth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Fifth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Sixth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Sixth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Seventh Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Seventh Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Eighth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Eighth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Ninth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Ninth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Tenth Student's Name

First Name*

Last Name*

Student's Date of Birth*

Date of Birth

Tenth Student's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Parent or Guardian's Email Address

Email*

Confirm Email*

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Emergency Contact Information

Emergency Contact Name *

Relationship to Student *

Phone Number *

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*

Date of Birth

Parent or Guardian's Information

AUTHORITY TO TREAT

Information of Medical Significance (allergies, medical diagnoses, etc.): *

Parent or Guardian's Signature*

Type Signature

Draw Signature

Click to Sign

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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