Release Waiver of Liability and Indemnity Agreement
Student Information:
First Name:
Last Name:
Date of Birth:
LIABILITY WAIVER
I understand and recognize that Jiu-Jitsu, Wrestling, Judo, MMA, Boxing, Strength & Conditioning, Yoga, and any other martial arts form not listed is a physically demanding activity and a sport that involves physical contact and risk of physical injury and that is taught using all precautions to avoid any injuries to myself or others. With all precautions made, you release Ralph Gracie Richmond, its agents, employees, that you the member or guardian of member or participant shall indemnify and hold harmless Ralph Gracie - Richmond, for all claims and causes of action. I, signing of behalf of myself or as guardian, hereby release and waive, hold harmless, and indemnify Ralph Gracie Richmond, RG East Bay LLC, its owners, employees, or agents from legal actions, claims, suits, expenses (medical, or attorney fees).
I understand, on behalf of myself or as guardian of member participating in activities that Ralph Gracie Richmond offers that negligence of any kind either known or foreseen, and with such damages, injury, paralysis, loss, or death results will not show negligence acted upon by Ralph Gracie Richmond.
I understand, agree, and abide that I as the participant, member or guardian of participant and member understand and will not act on any legal action, claim or lawsuits of any kind against Ralph Gracie Richmond as a result of bodily injury, paralysis, and death inside the facility or within 500 yards of facility.
With full knowledge of the aforementioned dangers, both to my person and my property (current and future), and after having these dangers fully explained to myself and/or to my legal guardian.
I, member or guardian of member, giving access and grant Ralph Gracie - Richmond, its employees or representatives to take photos of me and my property, and to publish and/or copyright on behalf of Ralph Gracie - Richmond. Also, to allow to publish, post, or use photography and videos with or without my name for advertising, illustrations, publishing, or publicity.
I hereby certify and declare that I will release and forever hold free and discharge from any liability Ralph Gracie Richmond and each of their agents, stockholders, directors, officers, employees, and representatives of and from all claims, demands, rights and causes of action of any nature whatsoever which may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from any participant in Ralph Gracie Richmond, their persons and entities mentioned above.
It is further understood that this waiver, release and assumption or risk is forever binding on my heirs or assigns.
My signature on this document is evidence that I know and understand and have had this document explained to me, that I fully understand the dangers that are inherent when participating at Ralph Gracie - Richmond I agree to the terms and conditions of this waiver form. I agree to the policies applied for all students of Ralph Gracie - Richmond presented at the time of registration and future changes implemented.
PHOTO RELEASE
I, , hereby grant and authorize Ralph Gracie Richmond the right to take, edit, alter, copy, exhibit, publish, distribute and make use of any and all pictures or video taken of me by Ralph Gracie Richmond to be used in and/or for legally promotional materials including, but not limited to, newsletters, flyers, posters, brochures, advertisements, fundraising letters, annual reports, press kits and submissions to journalists, websites, social networking sites and other print and digital communications, without payment or any other consideration. This authorization extends to all languages, media, formats and markets now known or hereafter devised. This authorization shall continue indefinitely, unless I otherwise revoke said authorization in writing. I understand and agree that these materials shall become the property of Ralph Gracie Richmond and will not be returned. I hereby hold harmless, and release Ralph Gracie Richmond from all liability, petitions, and causes of action which I, my heirs, representative, executors, administrators, or any other persons may make while acting on my behalf or on behalf of my estate. If the person signing is under the age of consent, then this release must be signed by a parent or guardian, as follows: I hereby certify that I am the parent or guardian of named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
Please sign Here to Agree to the terms and conditions of this Waiver Form:
Parent/Guardian Signature if under 18 years of age: