CONSENT, LIABILITY WAIVER, RELEASE AND INDEMNIFICATION AGREEMENT
Participant's Name: {name}
In consideration of being permitted to participate in any way, including travel to and from, any activities or events associated with AXT Jiu-Jitsu Inc., and/or it's affiliations, chartered clubs, individual members, or GXG LLC, I hereby:
1. Certify that I am in good physical condition and have no disease, illness or injury that would impair my ability to participate in aggressive exercise activities. I will notify the instructor staff of any conditions I have prior to class participation. - Member clicks to add their initials
2. Certify that I am aware of the nature of the martial arts of Brazilian Jiu-Jitsu, Judo, NoGi Grappling, MMA For the Street, and sports/fitness training, and I'm aware that there is a risk of injury, including but not limited to muscle strains, sprains, bone injury, head injury, permanent paralysis, cardiovascular/pulmonary/neurological complications, or death, as well as, the possibility of contracting various skin infections, and the possibility of accidental contact with blood from other individuals. I voluntarily and knowingly recognize, accept and assume all risk of injury relating to participation in these exercise activities. - Member clicks to add their initials
3. Acknowledge that in consideration for the privilege of participating at AXT Jiu-Jitsu, hereinafter referred to as AXTJJ; I agree to assume all responsibility for any injury, illness, property loss or death I may suffer during practice, traveling to or from practices, or other events. I do hereby for myself, my heirs, parents, guardians, executors, administrators, personal representatives and assigns, release, acquit, waive, forever discharge, hold harmless and agree to indemnify the owners of AXTJJ, including but not limited to their owners, officers, directors, representatives, staff, coaches, officials, volunteers, employees, members, and agents of and from any and all liability, claims, demands, costs, damages, actions, causes of actions, or suits of any nature or kind whatsoever which I, my heirs, parents, guardians, executors, administrators, personal representatives may now or hereafter have or claim to have, on account or or arising out of personal injuries, illness, death or damage to my person or property or involving any impairment or damage to any right, including, but not by limitation, right to be paid for loss of time, loss of service, or for expenses incurred, occurring to me because of, or in any way relating to, my training for, traveling to, participation in, or returning from practice, or associated events or through the use of any and all facilities connected therewith. - Member clicks to add their initials
4. Grant permission, in case of injury or illness, to have staff and/or medical professionals to examine me and if needed, provide me with medical assistance and/or treatment, and transport me to a facility that is off the premises of AXTJJ or organized event (if I cannot transport myself or have someone transport me). In consideration for such examination, or assistance, I do hereby for myself, my heirs, executors, administrators, parents, guardians and assigns, release, acquit, waive, and forever discharge AXTJJ, it's directors, employees, coaches or volunteers of, and from, any and all liability, actions, claims, demands or suits whatsoever, which I may now or hereafter have, or claim to have, on account of any injury sustained and suffered by me in connection with said medical assistance or treatment. - Member clicks to add their initials
5. Accept any and all financial obligations incurred as a result of any medical assistance, treatment, related experience provided in connection with any injuries which I may receive during AXTJJ events, or activities. - Member clicks to add their initials
6. Certify that I have read the above warning, waiver, and release, understand that I give up substantial rights by initialing and signing it, and knowing this sign it voluntarily. I agree to participate knowing the risks and conditions involved and do so entirely of my own free will. I affirm that I am at least 18 years of age, or, if I am under 18 years of age, I have obtained the required consent of my parent/guardian, as evidenced by their signature below. - Member clicks to add their initials
7. Certify that falsification of this document, on my part in any way, does not release myself from any responsibilities contained therein. - Member clicks to add their initials
- {sign_date} - Date document was signed (if applicable)
- - Name of the member or guardian signing the document (if applicable)
For Parents/Guardians of participants of minority age (under 18 years of age at time of registration)
This is to certify that I, as parent/guardian with legal responsibility for this participant, do consent and agree to his/her release, as provided above, of all the Releasees, and for myself, my heirs, assigns, and next of kin, I release and agree to indemnify and hold harmless the Releasees from any and all liabilities incident to my child's involvement or participation in these programs as provided above, even if arising from their negligence, to the fullest extent permitted by law. I have instructed the minor participant as to the above warnings and conditions and their ramifications. - Member clicks to add their initials
- {sign_date} - Date document was signed
- - Name of the member or guardian signing the document (if applicable)
AXT JIU-JITSU
