Loading...

Momentum Fitness & JiuJitsu

Liability Waiver, Assumption of Risk & Media Release

PLEASE READ CAREFULLY — THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS

In consideration of being allowed to participate in activities at Momentum Fitness & Momentum Jiu-Jitsu, including but not limited to fitness classes, strength training,Jiu-Jitsu,open gym use, and use of equipment and facilities, I acknowledge and agree to the following:

I understand that participation in physical fitness and martial arts activities involves inherent risks including, but not limited to, serious injury, illness, permanent disability, paralysis, and death. I voluntarily assume all risks, known and unknown, associated with participation at the Gym.

I certify that I am physically able to participate and have no condition that would prevent safe participation. I understand it is my responsibility to consult a physician if I have health concerns.

To the fullest extent permitted by law, I release and hold harmless Momentum Fitness & Jiu-Jitsu, its owners, coaches, employees, contractors, volunteers, affiliates, and landlords from any and all claims, liabilities, demands, damages, or causes of action arising from participation in activities, use of equipment or facilities, negligence, injury, illness, property damage, disability, or death.

I agree to follow all gym rules, policies, and coach instructions. I understand the Gym reserves the right to refuse or terminate participation for unsafe or inappropriate behavior.

I grant permission to Momentum Fitness & Jiu-Jitsu to photograph and/or video record me and to use my image, likeness, and voice for lawful promotional purposes including social media, website content, advertisements, marketing materials, and publications without compensation.

I understand the Gym is not responsible for lost, stolen, or damaged personal property.

If the participant is under 18 years of age, a parent or legal guardian must sign below. By signing, the parent/legal guardian agrees to all terms of this waiver on behalf of the minor participant and accepts full responsibility for the minor’s participation.

I HAVE READ AND UNDERSTAND THIS WAIVER AND AGREE TO ITS TERMS VOLUNTARILY.

Date: July 2, 2026

First Participant's Name
First Name*
Last Name*
Phone*
First Participant's Date of Birth*
Date of Birth
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
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(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*
Phone*
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!