I, {name} agree that {name} may participate in Brazilian Jiu Jitsu at Refuge Jiu Jitsu Academy.
RELEASE: In consideration of participation in Refuge Jiu Jitsu, I agree, on behalf of the above named child/children, his/her/their heirs and/or representative(s), to fully and forever release Refuge Jiu Jitsu Academy, and its officers, volunteers, agents, and employees from any and all liability, claims, demands, damages, actions, and causes of action whatsoever arising out of, related to, or
belonging to my child or me, related to Jiu Jitsu, exercise, physical activity, or any other activity, regardless of cause. This release covers everything that may occur at Refuge Jiu Jitsu Academy from the time that me or my child/children enters the premises of Refuge Jiu Jitsu Academy until the time that me or my child/children leaves the premises of Refuge Jiu Jitsu Academy.
CONSENT: To the best of my knowledge, the above-named can fully participate in the exercise and physical activity associated with Jiu Jitsu. I am aware of the risks and hazards connected with Brazilian Jiu Jitsu, exercise, and physical activity, and myself and my child/children hereby elects to voluntarily participate in Brazilian Jiu Jitsu, exercise, and physical activity, knowing that this may
be dangerous to us. I voluntarily assume full responsibility for any risks of loss, property damage, or personal injury that may be sustained by myself or my child/children, or any loss or damage to property owned by me or my child/children, as a result of engaging in Brazilian Jiu Jitsu, exercise, and physical activity at the premises of Refuge Jiu Jitsu Academy, regardless of the cause of any such incident.
COVID-19: Refuge Jiu Jitsu Academy is open and operating based upon the guidance of the state of California and local authorities. The best practices advised by the Centers for Disease Control and Prevention (CDC), and state and local authorities to mitigate the risk of infection and operate as safely as possible have been implemented and are being followed. As the facts about COVID-19 continue to evolve, Refuge Jiu Jitsu Academy will continue to be guided by federal, state, and local authorities, and
implement best practices accordingly. I acknowledge that Refuge Jiu Jitsu Academy is guided by state and local mandates regarding COVID-19. I also acknowledge the contagious nature of COVID-19, and that despite the best efforts of Refuge Jiu Jitsu Academy and adherence to federal, state, and local guidelines, my child/children or I may be exposed to or infected by COVID-19 by attending Refuge Jiu Jitsu Academy and that the risk of being exposed to or infected by COVID-19 at Refuge Jiu Jitsu Academy may result from the actions, omissions, or negligence of my child/children, myself, and others, including, but not limited to the owners, instructors, program participants, and family members of Refuge Jiu Jitsu Academy. I understand and accept sole responsibility for any injury or illness that my child/children or I may suffer, including but not limited to, personal injury, illness, disability, and death, as well as damage, loss, claim, liability, or expense of any kind, that my child/children or I
may experience or incur in connection with my child’s/children’s attendance at Refuge Jiu Jitsu Academy or participation in its classes, training, or programs. With full understanding and knowledge of the foregoing, on behalf of my child/children and myself, I knowingly and voluntarily assume all of the foregoing risks and understand, assume, and accept sole responsibility for any such injury
that my child or I may suffer.
HOLD HARMLESS: It is my express intent that this release and hold harmless agreement shall bind the members of my family and spouse (if any), if my child/children or I am alive, and the heirs, assigns, and personal representatives of my child/children and myself, if my child/children or I are not alive, and shall be deemed as a release, waiver, discharge, and covenant not to sue Refuge Jiu Jitsu Academy and its employees, agents, and representatives for any liability, claim, action, damages, costs or expenses of any kind, including any related to COVID-19, whether infection occurs before, during, or after participation in any programs at Refuge Jiu Jitsu Academy, I hereby further agree that this waiver of liability and hold harmless agreement shall be construed in accordance with
the laws of the state of California.
MEDICAL COSTS: I understand that Refuge Jiu Jitsu Academy will not be responsible for any medical costs associated with any injury that my child/children or myself may sustain.
RULES AND REGULATIONS: My child/children and I further agree to become familiar with the rules and regulations of Refuge Jiu Jitsu Academy concerning participant conduct and not violate them or any directive or instruction made by any instructor or any person or persons of responsibility of Refuge Jiu Jitsu Academy.
IMAGE/VIDEO RELEASE: I authorize the use and disclosure of my name, my child/children’s name(s), photo- graphic/video images, and/or testimonial for marketing purposes by Refuge Jiu Jitsu Academy. The photographic/video images, and/or testimonial will be used for: Social Media and/or Advertising. Participant agrees that any pictures, audio, or visual recordings taken of him/her in connection with training at Refuge Jiu Jitsu Academy can be used for publication, promotion, articles, shows and advertisement without additional consent and without compensation at this time or any other time.
MEDICAL TREATMENT CONSENT: I hereby further authorize in advance any necessary medical treatment required by the above- named, me, my child/children while in attendance at Refuge Jiu Jitsu Academy. I hereby authorize Refuge Jiu Jitsu Academy to summon emergency medical personnel, including paramedics, ambulance, and the police. I additionally hereby give permission to any such emergency medical personnel to take such measures and perform such actions that they reasonably believe to be required. I further agree to assume responsibility for the costs of any specialized evacuation and of any medical care and acknowledge have/will notify Refuge Jiu Jitsu Academy personnel of any medical needs or information required by the above- named child.
INFORMED AGREEMENT: I have reviewed this Agreement and am aware of the risks involved in participating in Brazilian Jiu Jitsu, exercise, and physical activity, and the possible injuries that may occur. Myself, my child/children freely and voluntarily agree to participate in Brazilian Jiu Jitsu, exercise, and physical activity conducted by REFUGE JIU JITSU ACADEMY. In signing this
release, I represent that I understand this Agreement, and sign voluntarily as an act of my own free will, and that REFUGE JIU JITSU ACADEMY has not made any oral representations, statement, or inducements apart from this Agreement. I am at least eighteen (18) years of age and fully competent to execute this Agreement. Also, I understand that all rules and regulations of REFUGE JIU JITSU ACADEMY will be enforced and any violation by my child/children or myself may result in myself, my child/children either temporarily or permanently being removed participation at or from the premises of REFUGE JIU JITSU ACADEMY
Member / Parent or Guardian Signature
{sign_date}
Refuge Jiu Jitsu
