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BASE CAMP BRAZILIAN JIU JITSU LLC—WAIVER OF LIABILITY

In consideration for being allowed to participate in personal training activities, martial arts and exercise programs with Base Camp Brazilian Jiu Jitsu LLC, a California limited liability company, (the "Club"), and for the use of its facility and equipment, in addition to any fee or charge, I forever waive, release and discharge the Club, its officers, agents, representatives and anyone acting on their behalf from all claims or liabilities for injuries, damages, or harm to my person or property, including those caused by the negligent act or omission of any of the previously identified parties. This waiver includes any claims or liabilities as a result of or in connection with my participation in any activities programs or services of the Club or the use of any equipment at any site or provided by the Club anywhere at any time. The risk of injury associated with the strength training, flexibility training, martial arts, cardiovascular exercise, and the use of exercise equipment, including the remote possibility of serious injury, disability, or death, has been fully explained to me. I am voluntarily participating in these activities and using the equipment with full knowledge of the hazards involved. I expressly assume any and all risk of injury or death. I declare myself in good health, suffering from no disease or impairment, which as a result of my participation in any activities or use of exercise equipment could cause harm to others around me or myself. I have been informed and it has been suggested that I consult a physician for approval before beginning in any exercise or training program of any kind. I have either consulted with a physician as recommended and have received permission to participate in any and all forms of exercise activities, or have decided to begin such types of exercise activities without such permission and now assume all responsibility and risk associated with my participation in any training programs, activities or use of equipment provided by the Club. 

Client/Parent initials

I authorize and consent to the Club, its officers, employees, independent contractors, and other agents recording (including video and audio), photographing, and otherwise capturing my image while I am on the premises of 612 S. Mt. Shasta Blvd #A. Mt. Shasta CA 96067 and any location at which I am present in my capacity as a member of the Club, including tournaments, seminars, and other events. With regard to any recording, photograph, or other image of me as provided in this consent, I further authorize and consent to the Club using my name and likeness without restriction, for any commercial or non-commercial purpose, including without limitation, for the purpose of commercially promoting the Club and any products (such as instructional videos, clothing, and posters) and services (such as classes, seminars, and private instruction) produced, provided, or sold by the Club. I unconditionally disclaim and waive any claims that the recording or use of my name and likeness as provided in this consent constitutes an invasion of my privacy and disclaim and waive any right to receive compensation or other payment from the Club in exchange for the recording or use of my name and likeness as provided in this consent. I give this consent knowingly and voluntarily. 

Client/Parent initials

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS WAIVER OF LIABILITY AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE CLUB. 

Today's date: June 27, 2022

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

I am the parent or legal guardian of the minor named above. I have the legal right to consent to and, by signing below, I hereby do consent to the terms and conditions of this Waiver of Liability. 

Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's 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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