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Team Third Law Academy Interview Sheet Kids & Teens

THIRD LAW, LLC Participant Agreement, Release, and Acknowledgement of Risk

In consideration of the services of Third Law, LLC, Roberto Torralbas, their agents, owners, officers, volunteers, participants, employees, and all other persons or entities who act in any capacity on their behalf (hereinafter collectively referred to as “Third Law Brazilian Jiu-Jitsu”), I hereby agree to release and discharge Third Law, LLC, Roberto Torralbas, on behalf of myself, my children, my parents, my heirs, assigns, personal representatives, and estate as follows:

1. I acknowledge that the study and training of Jiu-Jitsu, Wrestling, Thai Boxing, and all other Martial Arts entails known and unanticipated risks which could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties. I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. The risks include, among other things: intense, stressful, and strenuous exercises and body contact. I expressly consent to confront these known and unknown dangers and further agree, understand, and recognize that these risks may result in serious injury or illness including but not limited to: bruises, bloody noses, blood-borne pathogens, broken bones, heart attacks, or other cardiovascular diseases, or other serious injury resulting in death and/or property damage. Furthermore, I agree, understand, and recognize that Third Law, LLC Instructors have difficult jobs to perform. The instructors seek safety, but they are not infallible. They might be ignorant of a participant’s fitness or abilities. They may give inadequate warnings or instruction, and the equipment being used might malfunction.

2. I expressly agree and promise to accept and assume all of the risks existing in this activity. My participation in this activity is purely voluntary, and I elect to participate in spite of the risks.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Third Law, LLC from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Third Law, LLC’s equipment or facilities, including any such claims which allege negligent acts or omissions of Third Law, LLC’s or Roberto Torralbas.

4. Should Third Law. LLC, Roberto Torralbas, or anyone acting on their behalf be required to incur attorneys’ fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

5. I certify that I have adequate insurance to cover any injury or damage I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage myself. I further certify that I have no medical or physical conditions which could interfere with my safety in this activity, or else I am willing to assume – and bear the costs of all- risks that may be created, directly or indirectly, by any such condition.

6. In the event that I file a lawsuit against Third Law, LLC or Roberto Torralbas, I agree to do so solely in the state of Florida, and I further agree that the substantive law of that state shall apply in that action without regard to the conflict of law rules of that state.

By signing this document, I acknowledge that if anyone is hurt or property is damaged during my participation in this activity, I may be found by a court of law to have waived my right to maintain a law suit against Third Law, LLC or Roberto Torralbas, on the basis of any claim from which I have released them herein.

I HAVE READ THIS PARTICIPANT AGREEMENT, RELEASE, AND ACKNOWLEDGEMENT OF RISK, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

In consideration for being permitted to utilize the services and programs of Team Third Law Academy (Third Law LLC) in Naples, Florida for the purpose, including, but not limited to, observation or use of facilities or equipment, or participation in any off-site program affiliated with Team Third Law Academy. The undersigned, on behalf of himself or herself and such participating children and any personal representatives, heirs, and next of kin (hereinafter referred to as “the undersigned”) considered such premises, equipment and facilities and/or the affiliated program and that the undersigned finds and accepts same as being safe and reasonably suited for the use of participation by the undersigned and such participating children.

In addition, the undersigned acknowledges that novel coronavirus (“COVID-19”) infections have been confirmed throughout the United States, including several cases in Florida. In accordance with the most recent guidance and protocols issued by the World Health Organization (WHO), the Center for Disease Control (CDC), for slowing the transmission of COVID-19, the undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Team Third Law Academy within 14 days after (i) returning from highly impacted areas subject to a CDC Level 3 Travel Health Notice, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The CDC Travel Health Network is continuously updating this list and the undersigned agrees that they are aware of this list and the countries listed. The undersigned agrees to check the CDC Travel Health Notices list prior to utilizing the facilities, services, and programs of Team Third Law Academy, on a daily basis if necessary. The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs of Team Third Law Academy if he or she (i) experiences symptoms of COVID-19, including without limitation, fever, cough, or shortness of breath, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify Team Third Law Academy immediately if he or she believes that any of the foregoing access/use restrictions may apply.

Team Third Law Academy has taken certain steps to implement recommended guidance and protocols issued by Public Health Agencies for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that Team Third Law Academy may revise its procedures at any time based on updated recommended guidance and protocols issued by Public Health Agencies. The undersigned further acknowledges and agrees that, due to the nature of the facilities, services and programs offered by Team Third Law Academy, social distancing of 6 feet per person will be maintained when possible, but occasionally between students and coaches it may not be possible for safety reasons. The undersigned fully understand and appreciates both the known and potential dangers of utilizing the facilities, services and programs of Team Third Law Academy and acknowledges that use thereof by the undersigned and/or such participating children may, despite Team Third Law Academy’s reasonable efforts to mitigate such dangers, result in exposure to COVID-19, which could result in quarantine requirements, serious illness, disability and/or death.

IN FURTHER CONSIDERATION OF BEING PERMITTED TO ENTER TEAM THIRD LAW ACADEMY FOR ANY PURPOSE INCLUDING, BUT NOT LIMITED TO, OBSERVATION OR USE OF FACILITIES OR EQUIPMENT, OR PARTICIPATION IN ANY ON-SITE OR OFF-SITE PROGRAM AFFILIATED WITH TEAM THIRD LAW ACADEMY, THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING:

THE UNDERSIGNED, ON HIS OR HER BEHALF AND ON BEHALF OF SUCH PARTICIPATING CHILDREN, HEREBY RELEASES, WAIVES, DISCHARGES, AND COVENANTS NOT TO SUE TEAM THIRD LAW ACADEMY, its coaches or office employees, its owners, partners, joint venturers, directors, officers, independent contractors, employees, volunteers and agents (hereinafter referred to as “Releasees”) from all liability to the undersigned or such participating children and all personal representatives, assigns, heirs, and next of kin of the undersigned or such participating children for any loss or damage, and any claim or demands on account of any property damage or any injury to, or an illness or the death of, the undersigned or such participating children (or any person who may contract COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by the negligence, active or passive, of the Releasees or otherwise while the undersigned or such participating children are in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Team Third Law Academy.

THE UNDERSIGNED HEREBY AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releasees, and each of them, from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, of the Releasees or otherwise while the undersigned or any participating child is in, upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Team Third Law Academy. The undersigned understands and agrees that Team Third Law Academy is not required to provide insurance to cover the undersigned or such participating children in the event they suffer illness, injury, death, property loss, theft or damage of any sort upon, or about the premises or any facilities or equipment therein or participating in any program affiliated with Team Third Law Academy. The undersigned agrees and acknowledges that use of Team Third Law Academy facilities and services, and participation in Team Third Law Academy programs, may involve inherent danger and risk, including, without limitation, the risk of physical illness or injury, death or property damage.

THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to negligence, active or passive, of Releasees or otherwise while in, about or upon the premises of Team Third Law Academy and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with the Team Third Law Academy. The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by negligent first aid or emergency response of the Releasees and waive any claim in respect thereof.

THE UNDERSIGNED further expressly agrees that the foregoing ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of Florida and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM TEAM THIRD LAW ACADEMY IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 IN ANY TEAM THIRD LAW ACADEMY FACILITY OR PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING THEREFROM. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO TEAM THIRD LAW ACADEMY THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).

Notice of Physical Contact and Consent to Physical Contact

I CONSENT for my minor child, to practice with physical contact at Team Third Law Academy and accept any risks that may occur due to COVID-19. Parent/Guardian Initials

Please Complete Below for Consent to Physical Contact

Notice of Physical Contact

Complete martial arts training involves a wide variety of skills. While practicing skills, students may have contact with any portion of the body. The groin may be the target of kicks, strikes, and grabs during training by martial arts techniques, or incidentally contacted while performing a martial arts technique targeting another portion of the body. While male and female students train together, or when adult and minor students training together and in any other training combination, the purpose and intent of the school, 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 engaged in contact beyond the scope of training, or a training partner is taking undue or unacceptable advantage of training conduct, 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 the 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 either notified by the student or instructor, or both. Parent/Guardian Initials

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 contact of any partner seems beyond the scope of training or makes me uncomfortable. I agree to abide by the school etiquette in all manner pertaining, and shall not in any way conduct myself inappropriately or take inappropriate advantage of the contact martial arts training allows. Parent/Guardian Initials

Kids Program Parental Supervision Required or Drop Off Program Consent for Applicable Programs:

I understand if my child is signed up for one of Team Third Law’s introductory kids martial arts classes I am required to be on site supervising my child at all times. This includes Tiny & Little Ninjas.

Parent/Guardian Initials

I understand that if my child is signed up for one of Team Third Law Academy’s intermediate or advanced kids martial arts classes it is a program that allows Drop Off and is an Open Access Program Without Supervision. This includes Black Belt Club, Masters Club, Juniors & Teens.

I understand that Open Access means that the program:

Operates/serves children for less than four hours per day and may provide services during any out-of-school time, including before school, after school, on teacher planning days, holidays, and intercessions that occur during the school districts’ official academic calendar year.

Is not an after school child care program or a program that offers supervision.

Allows children to enter and leave the program at any time, without permission, prior arrangements, or supervision, and the program does not assume responsibility for supervision.

Does not provide transportation, directly or through a contract agreement with an outside entity, during the hours of operation for the purpose of field trips.

Does not serve or prepare any meals except those provided through the USDA After School Meal Program (AMP) administered by the Department of Health pursuant to Section 402.305(1)(c), F.S.

Does not contract to deliver the school readiness program pursuant to Section 1002.88, F.S. Initials Parent/Guardian Initials

I agree to receive text messages such as appointment reminders and account notices related to trying out Team Third Law and my enrollment. I understand that I can opt-out of these text messages at any time by notifying staff or responding to the texts and requesting to communicate by email instead.

   

I have read and understand the terms of this Assumption of Risk, Release and Waiver of Liability, and Indemnity Agreement and agree to its terms.

TODAY'S DATE: June 19, 2024

* Team Third Law Academy * 5707 Shirley Street * Naples, FL 34109 * (239) 628-3529 * www.TeamThirdLaw.com *

First Student's Name

First Name*

Middle Name

Last Name*

Phone*
First Student's Date of Birth*
First Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
First Student's Signature*
Second Student's Name

First Name*

Middle Name

Last Name*
Second Student's Date of Birth*
Second Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Third Student's Name

First Name*

Middle Name

Last Name*
Third Student's Date of Birth*
Third Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Fourth Student's Name

First Name*

Middle Name

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Fifth Student's Name

First Name*

Middle Name

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Sixth Student's Name

First Name*

Middle Name

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Seventh Student's Name

First Name*

Middle Name

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Eighth Student's Name

First Name*

Middle Name

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Ninth Student's Name

First Name*

Middle Name

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Tenth Student's Name

First Name*

Middle Name

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Student'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/Guardian Information

Mother (Guardian) *

Occupation *

Father (Guardian) *

Occupation *

Phone # *

Phone # *

Email: *
Emergency Contact Information

Emergency Contact: *

Relation: *

Emergency Contact Phone #: *

Email: *
How did you hear about us?
How did you hear about us? *
Google
Other Internet
Road Sign
Referral
Birthday
Drove-By
Facebook
Instagram
Youtube
Flyer
Contest Box
Mail-Out
TV
Radio

If referral:

If birthday:

In consideration of the minor(s) (“Minor”) being permitted by parent/guardian to participate in its activities and to use its equipment and facilities, I further agree to indemnify and hold harmless Third Law, LLC and Roberto Torralbas, from any and all claims which are brought by, or on behalf of Minor, and which are in any way connected with such use or participation by Minor.



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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
What Team Third Law Programs are you most interested in? (Check all that apply) *
Kids Martial Arts (ages 4-12: Mini Ninjas, Tiny Ninjas, Little Ninjas, Juniors, Black Belt Club)
After School Martial Arts & Academic Programs
Summer Camp
Teens Brazilian Jiu Jitsu & Muay Thai Kickboxing (ages 13 to 17)
Are you currently teaching and/or enrolled in a martial arts program?*
No
Yes

Martial Arts Background: *

Special Conditions (physical or mental conditions we should know about to keep you or your child safe): *

What are the two main goals you hope to achieve through training?



1. *

2. *
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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