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Lucas Lepri Jiu Jitsu Academy Fort Mill

Waiver and Release of Liability


June 27, 2022

I hereby enroll for Martial Arts training classes with Lucas Lepri Jiu Jitsu Academy Fort Mill, at 1852 Highway 160 SC - Suite 105, Fort Mill, SC 29708.

In consideration for being permitted to participate in Martial Arts training and all other related activities conducted by Lucas Lepri Jiu Jitsu Academy Fort Mill, I, myself, my spouse, legal representatives, heirs and assigns, hereby release, waive and discharge Lucas Lepri Jiu Jitsu Academy Fort Mill, its administrators, officers, directors, volunteers and employees, other participants (the releases) and if applicable owners and lessors of the premises on which the activities take place, from all liability (whether known or unknown) to me, my spouse, legal representatives, heirs and assigns for any and all loss or damage and any claim for damages resulting there from, on account of injury to my person, property, even injury resulting my death, whether caused by the negligence and/or gross negligence of the releases or otherwise while I am participating in said Martial Arts training or related activities.

Furthermore I agree and covenant not to institute or prosecute, or allow to be instituted or prosecuted or in any way to aid in the institution or prosecution of any lawsuit or claim against Lucas Lepri Jiu Jitsu Academy Fort Mill, at 1852 Highway 160 SC - Suite 105, Fort Mill, SC 29708. I hereby assume full responsibility for the risk of bodily injury, death or property damage due to the negligence of the release or otherwise while in or upon Lucas Lepri Jiu Jitsu Academy Fort Mill and or while participating in Martial arts. 

I agree to indemnify the releases and hold them each harmless from any and all loss, liability, damage or cost they may occur due to my presence at Lucas Lepri Jiu Jitsu Academy Fort Mill premises whether caused by the negligence of the releases or otherwise. I will indemnify, save and hold harmless each of the releases from any litigation expenses attorney fees, loss liability, damage, cost any release may incur as a result of such claim. I warrant I will not cause or attempt to cause any injury to myself or to any other participant, instructor or spectator I represent and warrant that I have consulted a licensed physician and that I am in good health and that are no physical or mental defects that would endanger my well-being or that of other participant or instructor. I give permission, free of charge, with no promise, representation or expectation of compensation, to use any photos, pictures, media, likeness of him/her for advertisements, instructional videos in any medium or matter, online training programs, or marketing materials to promote martial arts sports, martial arts or fitness. I expressly agree that this release, waiver and indemnity agreement is intended to be as broad and inclusive as permitted by the laws of the State of South Carolina and if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

I represent and warrant that I have carefully read the foregoing release and waiver and understand the contents thereof and sign this release as my own free act and further agree that no oral representations, statements or inducements apart from the foregoing written agreement have been made.

ACKNOWLEDGEMENT AND RELEASE FORM (WAIVER OF LIABILITY) COVID-19 Supplement

This is a supplement to our standard waiver of liability to include special COVID-19 related items.

The undersigned acknowledges that the disease caused by the novel coronavirus (COVID-19) has been confirmed throughout the United States. In accordance with the most recent guidance and protocols issued by the Centers for Disease Control and Prevention (CDC) and the state Department of Health 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 (other than any online services) within 14 days after (i) returning from a highly impacted area subject to CDC Level 3 Travel Health Notices, (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 complete CDC Travel Health Notice is continuously updated at https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html and the undersigned agrees that they are aware of this list and the countries listed.

The undersigned hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs (other than any online services) if he or she (i) experiences symptoms of COVID-19, including cough, shortness of breath or difficulty breathing, fever, chills, headache, sore throat, muscle pain, or new loss of taste or smell, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify us immediately if he or she believes that any of the foregoing access/use restrictions may apply.

We have taken certain steps to implement recommended guidance and protocols for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that we may revise those procedures at any time based on updated guidance and protocols and further agrees to comply with the revised procedures prior to utilizing our facilities, services, or programs (other than any online services).

In further consideration of being permitted to enter our facility for any purpose including, but not limited to, observation or use of facilities or equipment, or participation in any on-site program, the undersigned hereby agrees to the following:

The undersigned, on his or her behalf, and on the behalf of such participating children, hereby releases, waives, discharges, and covenants not to sue Lucas Lepri Jiu Jitsu Academy Fort Mill, its administrators, officers, directors, volunteers and employees, other participants (the releases) from all liability to 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 contact COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by negligence, active or passive, of Lucas Lepri Jiu Jitsu Academy Fort Mill or otherwise while the undersigned or such participating children are in, upon, or about the premises. 

The undersigned hereby agrees to indemnify and save and hold harmless Lucas Lepri Jiu Jitsu Academy Fort Mill, its administrators, officers, directors, volunteers and employees, other participants (the releases), and each of them, from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, or otherwise while the undersigned or any participating child is in, upon, or about the premises of Lucas Lepri Jiu Jitsu Academy Fort Mill. 

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 LUCAS LEPRI JIU JITSU ACADEMY FORT MILL IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 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 A 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 THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).


First Student's Name

First Name*

Last Name*

Phone*
First Student's Date of Birth*
First Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
First Student's Signature*
Second Student's Name

First Name*

Last Name*
Second Student's Date of Birth*
Second Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Third Student's Name

First Name*

Last Name*
Third Student's Date of Birth*
Third Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Fourth Student's Name

First Name*

Last Name*
Fourth Student's Date of Birth*
Fourth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Fifth Student's Name

First Name*

Last Name*
Fifth Student's Date of Birth*
Fifth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Sixth Student's Name

First Name*

Last Name*
Sixth Student's Date of Birth*
Sixth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Seventh Student's Name

First Name*

Last Name*
Seventh Student's Date of Birth*
Seventh Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Eighth Student's Name

First Name*

Last Name*
Eighth Student's Date of Birth*
Eighth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Ninth Student's Name

First Name*

Last Name*
Ninth Student's Date of Birth*
Ninth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Tenth Student's Name

First Name*

Last Name*
Tenth Student's Date of Birth*
Tenth Student's Information
If Adult: Current belt rank
If Minor: Current belt rank
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
How did you hear about us?
How did you hear about us? *

Referral? (First and Last name)

Other (Please explain)
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:*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
If Adult: Current belt rank
If Minor: Current belt rank
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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