PARENTAL/LEGAL GUARDIAN CONSENT AND RELEASE
PLEASE READ CAREFULLY
THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS
WAIVER / RELEASE / ASSUMPTION OF RISK
I understand and have had explained to me that the martial art known as “Gracie Jiu-Jitsu” is taught using precautions to avoid any injuries. However, participation in the Gracie Jiu-Jitsu classes carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks range from minor injuries such as scratches, bruises, and sprains, to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, to catastrophic injuries including paralysis and death.
I understand and have had explained to me that, along with the possibility of personal injury, injury to property is also possible, such as, but not limited to possible loss of wages and the ability to earn such wages.
I understand that no amount of care, caution, instruction or supervision can eliminate the dangers inherent in the activities related to Gracie Jiu-Jitsu. With full knowledge of the aforementioned dangers, both to my child’s person and to my child’s and my property (current and future), and after having these dangers fully explained to me , I nevertheless desire for my minor child (or the child to whom I am guardian) to participate in Gracie Jiu-Jitsu training and activities.
In consideration of __________________________ (print minor child’s name) being permitted to participate in Gracie Jiu-Jitsu training and activities and use Gracie Jiu Jitsu Seguin services, I as parent or guardian of said minor child, and on behalf of my myself, my child, our personal representatives, heirs, next of kin, spouse, legal representatives, executors, administrators, attorneys, agents, beneficiaries, successors and assigns (hereinafter collectively “Releasing Parties”) further agree to assume the risk of harm to my child, agree to release the Gracie Parties (defined below) from all liability for all injury of any kind to my minor child, and agree to defend, save, protect, indemnify and hold harmless the Gracie Parties from any claims which are brought by, because of or on behalf of my minor child which are in any way arising out of or in connection with such use or participation by my minor child in Gracie Jiu-Jitsu training and activities, as more fully set forth below.
In consideration of being allowed to participate in Gracie Jiu-Jitsu training and activities and use Gracie Jiu Jitsu Seguin services, goods, equipment and facilities, on behalf of myself and all Releasing Parties, I hereby release, waive, covenant not to sue, and forever hold free and discharge from any liability from Gracie Global LLC, d.b.a. Gracie Jiu Jitsu Seguin and each of its affiliates, all the foregoing’s successors, licensees and assigns, and each of the foregoing’s agents, stockholders, principals, directors, officers, employees, contractors, instructors, volunteers and representatives (collectively, the “Gracie Parties”), of and from all claims, demands, rights and causes of action of any nature whatsoever, arising out of or in connection with the conduct, acts or omissions, products, services, land or building conditions, equipment, and facilities of the Gracie Parties, and my or my child’s use thereof, including, but not limited to those claims arising from and by reason of any and all bodily or personal injury, damage to property or other loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from my or my child’s participation in Gracie Jiu-Jitsu, and any and all claims arising out of or in connection with any unsupervised minor children on Gracie Parties’ property and facilities or who wander away from or loiter by said property and facilities. I further understand and acknowledge that Gracie Parties expressly disclaim any responsibility to supervise minor children wandering away from or loitering by Gracie Parties’ property and facilities, and that I am responsible for monitoring and attending to my minor children, regardless of whether such children are participating in Gracie Jiu-Jitsu activities and training or not.
Further, knowing and understanding these risks, nevertheless I on behalf of all Releasing Parties hereby agree to voluntarily assume these risks and to release and hold harmless the Gracie Parties in connection with or arising out of the conduct, acts or omissions, products, services, land or building conditions, equipment, and facilities of the Gracie Parties, and my use thereof. It is further understood that this waiver, release and assumption of risk is forever binding on all Releasing Parties. I certify that I have adequate insurance to cover any injury or damage I or my minor child may cause or suffer while participating, or else I agree to bear the costs (including any insurance deductibles) of such injury or damage myself. I further understand and certify that I am willing to assume the risk of any medical or physical condition I or my minor child may have.
I also agree to defend, save, protect, indemnify and hold harmless the above-named Gracie Parties in the event that I or any member of my family or those persons I am guardian of, causes personal injury or property damage to any person or property during Gracie Jiu Jitsu Seguin activities. I understand that this indemnification includes payment for all loss, including any court or arbitration costs, attorney’s fees, awards incurred by or adjudged against the above-named Gracie Parties.
If any portion of this agreement is found to be void or unenforceable, I agree that the remaining portions shall remain in full force and effect.
I am also aware that for purposes of safety, security and quality control there are surveillance cameras mounted throughout Gracie Jiu Jitsu Seguin. Furthermore, because of the popularity of Gracie Jiu Jitsu Seguin, I understand and acknowledge that often times filming, video or photographs may be taken of me or my minor child during classes/training. I hereby grant Gracie Global LLC, d.b.a. Gracie Jiu Jitsu Seguin and its successors, licensees and assigns the unlimited use of my photo, likeness and voice in any format of video recording (e.g., DVD) for promotional advertisement or commercial use in any format now known or hereafter devised, in perpetuity and I forfeit any form of payment or credit in connection therewith. To be a participant in Gracie Jiu-Jitsu training and activities in such video recording, or photos is my or my minor child’s consideration for the rights granted above. It is further understood that I will not film, video, photograph or otherwise record any classes or training without the express prior permission from Gracie Jiu Jitsu Seguin on a case by case basis.
My signature on this document is evidence that I know and understand and have had all my questions concerning this document explained to me, that I fully understand the dangers that are inherent in this martial art and that I voluntarily certify that I and all Releasing Parties will not hold the Gracie Parties, Gracie Global LLC, dba Gracie Jiu Jitsu Seguin, Ryron Gracie, Rener Gracie, or any members of the extended Gracie family, or any of the foregoing’s successors, representative, licensees and assigns, and any of the foregoing’s agents, stockholders, principals, directors, officers, employees, contractors, instructors, volunteers and representatives, responsible for any injury or loss of any kind, whether as a result of training or not. I acknowledge on my behalf and all Releasing Parties’ behalf that (a) I am signing this document freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law, and (b) I understand that I am giving up substantial rights, including the right to sue.
In addition, I agree to strictly abide by the policies applied for all students of Gracie Jiu Jitsu Seguin presented at the time of registration and future changes implemented.
In case of an emergency and I cannot be reached, I authorize the staff of the Gracie Jiu Jitsu Seguin to obtain whatever medical treatment he/she deems necessary for the welfare of my minor child listed on this document. I further understand that I will be financially responsible for all charges and fees in the rendering of said emergency treatment, regardless of whether or not my minor child’s medical insurance would cover such charges and fees. I acknowledge that I have had an opportunity to have this Release reviewed by competent legal counsel, and to the extent that I have not done so, I have intentionally waived my right to do so.
PRINT PARENT/LEGAL GUARDIAN’S NAME:_________________________________________________
PARENT/LEGAL GUARDIAN’S SIGNATURE:__________________________________________________
Emergency contact information: Contact Name:______________________________________
Home Phone:_______________________________________
Work Phone:_______________________________________
Mobile Phone:______________________________________
Email:_____________________________________________
Gracie Jiu-Jitsu Seguin