Name *

First Name

Last Name

Phone *

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Payment Option

Payment required at the door

Cash

Venmo

Confirmation of Waiver of Liability *

I HAVE READ AND AGREE TO THE FOLLOWING WAIVER OF PARTICIPATION. I hereby assume full responsibility and liability for all damages, injuries and losses that I or my child may sustain or incur while participating in or watching during my entire tenure as a trial member or student of Ethos Jiu-Jitsu Inc. I realize that serious injury is common place in martial arts participation such as the one I am hereby entering and that death is a possibility. I also realize that if I or my child are injured, I or my child might be disfigured, disabled and/or rendered unable to work again. By entering into this trial and/or membership I agree to and fully accept and assume liability for any and all injuries that I or my child may incur expressly give up and waive any and all claims that I or anyone acting on my behalf or through me might have against Ethos Jiu-Jitsu Inc., it's board members, the promoters, operators, sponsors, officials, participants, non-participants, or volunteers for any injury regardless of its nature, effect or affect on me as a result of mine or my child's participation and/or presence at Ethos Jiu-Jitsu Inc classes or training at Ethos Jiu-Jitsu Inc. at any point in time. Jiu-Jitsu is a full contact activity. In participating in this activity at Ethos Jiu-Jitsu Inc, could potentially expose you to Covid 19. I understand that Ethos Jiu-Jitsu Inc. cannot be held liable for any exposure to the COVID-19 virus. Symptoms of COVID-19 include: Fever, Fatigue, Dry Cough, Difficulty Breathing. I agree to the following: I understand the above symptoms and affirm that I, as well as all household members, do not currently have, nor have experienced the symptoms listed above within the last 14 days. I affirm that I, as well as all household members, have not been diagnosed with COVID-19 within the past 14 days. I affirm that I, as well as all household members, have not knowingly been exposed to anyone diagnosed with COVID-19 within the past 14 days. I authorize, and agree to hold harmless, whatever medical personnel that may be present at the Ethos Jiu-Jitsu Inc. to take any action necessary, should I become injured. I represent that I and my child are in good health; that I and my child are not presently, nor will I or my child participate while under the influence of any drug or medication; that no one affiliated with Ethos Jiu-Jitsu Inc. has encouraged me to enter or made any representations regarding mine or my child's fitness or ability to participate; that I have read and understood every provision of this release; and that I am legally competent to and freely enter into this waiver, release and assumption of risk agreement. In case of minors under 18 years old. Furthermore, if the competitor is a minor I, hereby certify that I am parent and/or legal guardian of the above named minor who has been given my express permission to participate in the trial or membership for which we are registering. And, that I have read and understood every provision of the release of liability and that I am legally competent to and freely enter into this release of liability and assume all risk on behalf of the minor (participant) named herein and any and all successors, assigns or any other representative acting upon the minor's behalf.