Participant name: {name}

I, upon my own initiative, the above referenced participant / parent / legal guardian attests to the following: risk & responsibility will participate in Brazilian Jiu-Jitsu at Triple Threat Jiu-Jitsu.

I am at least 18 years of age, if I am under 19 years of age, a parent or legal guardian will sign waiver on my behalf.

I understand that Jiu-Jitsu can cause serious injury or even death.  I will be learning how to immobilize an opponent by choking them unconscious or major trauma to a joint such as shoulder, knees, ankles, neck, elbows, or wrists.  At some point everyone who trains Jiu-Jitsu long enough will suffer at least a minor injury.  Knowing all the above, I freely choose to participate in class and accept these risks.

Therefore, I do release and hold harmless, Triple Threat Jiu-Jitsu & the instructors: Prof. Mario Fonseca, Prof. David, Dusty Gustin, Jennifer Fonseca, Jesse Tobar, Brandon Crawford, Jim Coursey, Roger Harrell and their assistants from any liability, negligence, claims demand, actions, or cause of actions resulting from any participation in this sport / activity / class and associated activity within Triple Threat Jiu-Jitsu.

Photography does occur in the gym both by surveillance cameras and by our resident photographer.  If you require no photography, please let the photographer and teacher know and we will honor your request and not take pictures.  We do not share surveillance footage of children unless there is a legal reason to do so.  We do share video footage of adults from time to time.

Participant's date of birth: {dob}

Cell: {phone}

Emergency Contact Information

Contact Name: {contact_name}

Contact Phone Number: {contact_phone}

Contact Relationship: {contact_relation}

Participant Signature:

Date: {sign_date}