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Signal Mountain Jiu Jitsu


SIGNAL MOUNTAIN JIU JITSU LLC.

RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT

In consideration of participating in the sport of martial arts, and for other good and valuable consideration, I hereby agree to release and discharge from liability arising from negligence Signal Mountain Jiu Jitsu LLC. and its owners, directors, officers’ employees, agents, volunteers, participants, and all other persons or entities acting for them (hereinafter collectively referred to as “Releasees”), on behalf of myself and my children, parents, heirs, assigns, personal representative, and estate, and agree as follows: 

1. I acknowledge that the activity of martial arts involves known and unanticipated risks which could result in physical oremotional injury, paralysis or permanent disability, death, and property damage. Risks include, but are not limited to, death, paralysis, broken bones, torn ligaments, bruises, and other bodily injuries caused by contact with other participants, objects used during martial arts activities, or walls, matting or the floor; medical conditions resulting from physical activity; and damaged clothing or other property. I understand such risks simply cannot be eliminated, despite the use of safety equipment, without jeopardizing the essential qualities of the activity.

 

2. I expressly accept and assume all risks inherent in this activity or that might have been caused by the

negligence of the Releasees. My participation in this activity is purely voluntary and I elect to participate despite the risks.

In addition, if at any time I believe that event conditions are unsafe or that I am unable to participate due to physical or medical conditions, then I will immediately discontinue participation.

3. I hereby voluntarily release, forever discharge, and agree to indemnify and hold harmless Releasees from all claims, demands, or causes of action which are in any way connected with my participation in this activity, or my use of their equipment or facilities, arising from negligence. This release does not apply to claims arising from intentional conduct. Should Releasees or anyone acting on their behalf be required to incur attorney’s fees and costs. to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs.

 

4. I represent that I have adequate insurance to cover any injury or damage I may suffer or cause while participating in this activity, or else I agree to bear the costs of such injury or damage myself. I further represent that I have no medical or physical condition 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.

 

5. In the event a lawsuit is filed, I agree to do so solely in the state {TN} where Releasees’ facility is located, and I furtheragree that the substantive law of the State of Tennessee shall apply.

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6. I agree that if any portion of this agreement is found to be void or unenforceable, the remaining portions shall remain in full force and effect.

By signing this document, I agree that if I am hurt or my property is damaged during my participation in said activity, then I may be found by a court of law to have waived my right to maintain a lawsuit against the parties being released based on any claim for negligence.

I have had sufficient time to read this entire document and, should I choose to do so, consult with legal counsel prior tosigning. Also, I understand that this activity might not be made available to me or that the cost to engage in this activity would be significantly greater if I were to choose not to sign this release and agree that the opportunity to participate at the stated cost in return for the execution of this release is a reasonable bargain. I have read and understood this document and I agree to be bound by its terms.

 

Signature Print Name ___________________________________

Address City State Zip ___________________________________

Telephone (                ) Date ________________

 

PARENT OR GUARDIAN ADDITIONAL AGREEMENT

(Must be completed for participants under the age of 18)

 

In consideration of _________________________________ (PRINT minor’s names) being permitted to participate in thisactivity, I further agree to indemnify and hold harmless Releasees from any claims alleging negligence which are brought by or on behalf of minor or are in any way connected with such participation by minor.

 

Parent or Guardian Print Name Date: _________________________________________

(If notarization is necessary, please sign & stamp this side of form.)

 

SIGNAL MOUNTAIN JIU JITSU LLC.

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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 or Guardian's Driver's License / ID Card

Driver's License / ID Card Number*

Issuing State*
SIGNAL MOUNTAIN JIU JITSU LLC. Name ____________________________​Phone ______________________ Email ____________________________​DOB ________________________ Address _____________________________________________________________ What experience do you have with Martial Arts {i.e. Wrestling, Boxing, Striking Martial Arts, none}? ___________________________________________________________________________ How did you hear about SMJJ ? ________________________________________________ Do you have any health conditions we should know about? ________________________________________________ What are your goals for training Jiu Jitsu? ________________________________________________ If you could be any animal that matches your personality what would you be? ________________________________________________ If you could be any Superhero for 1 week who would you be? ________________________________________________ Pick one: Exotic sports car, 4x4, Economy car ____________________________________ Favorite type of music? _____________________________________ Beach or Mountains? _____________________________________
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*

Middle 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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