STUDENT PERSONAL INFORMATION
In consideration of my attendance and participation in the martial arts training offered by
(insert legal name with the LLC or whatever type of company it is), also known as Memorial Brazilian Jiu-jitsu (referred to herein as “Memorial BJJ”), I, the student, on behalf of myself, member of my family, my heirs, executors, administrators, and assigns, (1) hereby forever release, discharge and hold harmless Jackson Fortunato and Memorial BJJ, and their representatives, employees, contractors, agents or other participants in their various programs for any injury, loss or damage to my person or property howsoever caused, arising out of or in connection with my taking part in Memorial BJJ classes, lessons, Self Defense Seminars and other activities and notwithstanding that the same may have been contributed to or occasioned by the negligence of Jackson Fortunato and Memorial BBJJ, and their representatives, employees, contractors, agents or other participants in their various programs (2) represent and warrant that to the best of my knowledge I am in good physical condition and fully able to participate in all programs and (3) acknowledge that due to the physical nature of the programs offered by Memorial BJJ, that my participation in them risks my physical health and could result in serious injury, including but not limited to permanent injury, paralysis or death, and I voluntarily assume all such risks.
The student further acknowledges, agrees and/or consents:
1. In case of injury to the student to have a doctor, nurse, athletic training, or other emergency medical personnel provide me with medical assistance or treatment for such injury.
2. The student confirms that there were no verbal representations other than those specified in this agreement, or otherwise specified in writing.
3. The student may be photographed or filmed while attending the premises of Memorial Brazilian Jiu-jitsu and he/she gives permission to Memorial Brazilian Jiu-jitsu and any affiliates to use any and all photos, video footage, and/or video streaming for promotional, sales, publicity, and advertising purposes for all media including internet.
4. The waiver was read and the student agrees to abide by it.
*A 30 day notice is required before cancellations or temporary holds can be processed on the account*