RELEASE, INDEMNIFICATION, AND HOLD HARMLESS AGREEMENT
In consideration of being allowed to participate in any way in the events of Mooresville Brazilian Jiu Jitsu, I,
- Recognize and understand that martial arts training is a physical contact activity and that my participation might result in serious injury, including permanent disability or death, and severe economic loss. Martial arts have an inherent risk of injury, including common minor events, some possible serious events and possible catastrophic events.
- Recognize and understand that such risk may be due to not only my actions, but also the action, inaction or negligence of others, the regulations of participation, or the conditions of the premises or any of the equipment used.
- Recognize that there may be other risks that are not known to me or others or not reasonable foreseeable this time.
- Agree to inspect the facilities, equipment and pairings prior to participation. I will immediately inform the instructor if I believe that anything is unsafe or beyond my capability and refuse to participate.
- Recognize that participation includes possible exposure to and illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.
Assumption of risk
- Assume all of the foregoing risks and accept personal responsibility for any damages that may result from injury, permanent disability or death. I do this knowing that there is an inherent risk of injury, including common minor events, some possible serious events and possible catastrophic events. These may include but are not limited to, scrapes, bruises, fractures, broken bones, loss of consciousness, concussion, death and or paralysis.
- Enter martial arts training and/or competition entirely of my free will and understand the importance of following the rules of training and competition. I have reviewed a copy of the rules and regulations of Mooresville Brazilian Jiu Jitsu and agree to abide by the instructions given therein.
- Grant permission in case of injury to have a doctor, nurse, athletic trainer, or other emergency medical personnel provide me with medical assistance or treatment for such injury.
- Release, waive, discharge and covenant not to sue Mooresville Brazilian Jiu Jitsu LLC, its affiliated organizations and governing bodies, their officers, instructors and personnel, other members of the organizations, participants, supervisors, coaches, sponsoring organizations and their agents, and if applicable, owners and leasers of the premises from any liability to the undersigned, his/her next of kin for any and all claims, demands, losses and damages which may be sustained and suffered on account of injury, including death or damaged property, caused or alleged to be caused in whole or partially by negligence of the releases or otherwise.
- I know the inherent risks of this activity, understand those risks, appreciates those risks, and agrees to assume responsibility for those risks.
Photo Release
In addition, I grant permission to Mooresville Brazilian Jiu Jitsu. and its agents or employees, to use photographs taken of me or my minor child/children in classes or events of Mooresville BJJ. for use in publications such as brochures, newsletters, and magazines, and to use the photographs on display boards, and to use such photographs in electronic versions of the same publications or on Mooresville BJJ web sites or other electronic form or media, and to offer them for use or distribution in other non-company publications, electronic or otherwise, without notifying me. I hereby waive any right to inspect or approve the finished photographs or printed or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the photograph. I hereby agree to release, defend, and hold harmless Mooresville BJJ and its agents or employees, including any firm publishing and/or distributing the finished product in whole or in part, whether on paper or via electronic media, from and against any claims, damages or liability arising from or related to the use of the photographs, including but not limited to any misuse, distortion, blurring, alteration, optical illusion or use in composite form, either intentionally or otherwise, that may occur or be produced in taking, processing, reduction or production of the finished product, its publication or distribution.
- {name} - Full name
- {dob} - Date of birth
- {address} - Member address
- {phone} - Phone number
- {contact_name} - Emergency contact (if member has any)
- {contact_phone} - Emergency contact phone
- {contact_relation} - Emergency contact relation
{sign_date} - Date document was signed (if applicable)