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Release and Waiver of Liability and Indemnity Agreement

(Read Carefully Before Signing)

In consideration of being permitted to participate in any way in the Martial Arts Program at HARBOR JIU JITSU LLC located at 3003 English Creek Avenue Suite D-08 Egg Harbor Township New Jersey 08234 and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree:

1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in any martial arts activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE; I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.

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2. I/We fully understand and acknowledge that:

a. There are risks and dangers associated with participation in martial arts events and activities which could result in serious and severe bodily injury and/or damages.

b. The social and economic losses and/or damages, which could result from these risks and dangers could be severe.

c. These risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, HARBOR JIU JITSU LLC and/or their agents.

d. There may be other risks not known to us or are not reasonably foreseeable at this time.

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3. I/We accept and assume such risks and responsibility for the losses and/or damages following such injury, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of HARBOR JIU JITSU LLC and/or their agents.

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4. I/We HEREBY RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE HARBOR JIU JITSU LLC and/or the facility used by the participant, including it’s owners, manager, promoters, lessees of premises used to conduct the martial arts activities, events or programs, and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees from all liability to the participant for any and all claims, demands, losses or damages and any claims or demands on account of any injury, including but not limited to the death of the participant, or damage to property, arising out of or relating to the event(s) caused, alleged to be caused in whole or in part by the negligence of HARBOR JIU JITSU LLC, or otherwise.

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5. I/We HEREBY acknowledge that THE ACTIVITIES AND THE EVENT(S) ARE VERY DANGEROUS and involve the risk of serious injury and/or death and/or property damage. Each of THE UNDERSIGNED also expressively acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OPERATIONS OR PROCEDURES OF HARBOR JIU JITSU LLC, OR OTHERWISE.

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6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the activities or event is conducted. In the event that any term or portion of this Agreement is held to be unenforceable or invalid, it is the intention of the parties that the remaining portions of the Agreement are binding and continue in full legal force and effect.

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7. On behalf of the participant and individually, the undersigned parent(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against HARBOR JIU JITSU LLC, and/or their agents, the parent(s) and or legal guardian(s) will reimburse them for any money which they have paid to the participant, or on his/her behalf, and hold them harmless.

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I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, 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.

Martial Arts School: Harbor Jiu Jitsu LLC

Date: July 4, 2025

 



First Student's Name
First Name*
Last Name*
Phone*
Select Gender
First Student's Date of Birth*
Date of Birth
First Student's Signature*
Second Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Third Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Fourth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Fifth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Sixth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Seventh Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Eighth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Ninth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Tenth Student's Name
First Name*
Last Name*
Phone*
Select Gender
Student's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email*
Confirm Email*
How did you learn about Harbor Jiu Jitsu? *
Emergency Contact
First Name*
Last 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.


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*
Relationship*
Phone*
Select Gender
Parent or Guardian's Date of Birth*
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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