Brazilian Jiu-Jitsu (BJJ) Participation Waiver, Release of Liability, and Indemnity Agreement
1. Participant & Legally Authorized Representative Participant Full Name: {name} Date of Birth: {dob} Address: {address} Phone Number: {phone} Emergency Contact: {contact_name} ({contact_phone}) — {contact_relation}
If the participant is under 18, the undersigned is the participant's parent or legal guardian with full authority to sign on their behalf.
2. Express Assumption of Risk (Inherent Risks) I, {first_name}, on behalf of myself and, to the extent permitted by law, the participant (including if a minor), acknowledge that Brazilian Jiu-Jitsu (BJJ) is a full-contact combat sport with significant inherent risks, including unforeseen accidents. I understand these risks and voluntarily assume all known and unknown risks of injury, including but not limited to:
- Physical injury (e.g., strains, sprains, fractures, dislocations, torn ligaments/tendons, concussions, brain injury, paralysis, or death).
- Injuries from falls, throws, submission holds (joint locks, chokes), collisions with participants, walls, mats, or equipment.
- Transmission of communicable diseases (e.g., MRSA, Staph, Ringworm, viral infections).
- Risks from academy-related activities, including travel to or participation in tournaments, seminars, or events (whether as a representative of Midwest BJJ, LLC or otherwise).
I assume these risks even if they arise from the ordinary negligence of the Releasees (defined below).
3. Release and Waiver of Liability (Ordinary Negligence Only) In consideration of participation at Midwest BJJ, LLC, I, on behalf of myself, the participant (to the extent permitted by law), and our heirs, executors, and assigns, hereby RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Midwest BJJ, LLC, its owners, members, managers, instructors, employees, volunteers, and agents (collectively, the "Releasees") from any and all claims, liability, or causes of action arising from participation or presence at the facility or academy-related activities.
This release applies specifically (and only) to injury, loss, or damage caused by the ordinary negligence of the Releasees, including negligent instruction, supervision, maintenance, sanitation, repair, emergency response, or first-aid referral. It does not apply to gross negligence, recklessness, or intentional conduct.
4. Indemnification and Hold Harmless I agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS the Releasees from all claims, losses, costs, and expenses (including reasonable attorneys' fees) arising from the participant's presence or activities, even if caused by the Releasees' ordinary negligence. If the participant is a minor, I (as parent/guardian) specifically agree to indemnify the Releasees for any claims brought by or on behalf of the minor, and I covenant not to sue or assist any claim on the minor's behalf.
5. Medical Authorization and Physical Fitness I certify that the participant is in good physical health, has no known conditions that would impair safe participation, and (if applicable) has consulted a physician. I recommend that the participant maintain health insurance. In an emergency, I authorize the Releasees to call 911 or seek emergency medical assistance from qualified professionals and consent to emergency treatment and transportation as needed. I accept sole responsibility for all associated costs.
6. Irrevocable Media Release I grant Midwest BJJ, LLC an irrevocable, perpetual, royalty-free right to use the participant's name, image, likeness, and voice in photographs, videos, or recordings for any lawful purpose, including promotion and advertising.
I release the Releasees from claims arising from such use, including invasion of privacy, defamation, libel, or emotional distress. I waive any right to inspect or approve the materials or their use.
7. Governing Law, Venue, and Severability This Agreement shall be governed by the laws of the State of Iowa, without regard to conflict of laws principles. Any legal action shall be brought exclusively in the state or federal courts in Iowa, and I consent to jurisdiction and venue there. If any provision is held invalid, the remainder shall remain in full effect.
8. FINAL ACKNOWLEDGMENT BY SIGNING BELOW, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS AGREEMENT. I UNDERSTAND THAT I AM RELEASING AND WAIVING SUBSTANTIAL RIGHTS (INCLUDING, TO THE EXTENT PERMITTED BY LAW, THE RIGHT TO SUE FOR ORDINARY NEGLIGENCE) AND AGREEING TO INDEMNIFICATION. I SIGN FREELY AND VOLUNTARILY, WITH NO INDUCEMENT OUTSIDE THIS DOCUMENT.
Signature (Participant if 18+, or Parent/Guardian if under 18):
Date signed: {sign_date}
