Gracie Charleston Waiver


Student Name *
Student Name
Address *
Address
Phone
Phone
In case of emergency contact *
In case of emergency contact
Phone *
Phone
What is your reason for training? check all that apply
Instructor, Rank, Years of experience
(If under 18 years old, must have parent or guardian)
(If under 18 years old, must have parent or guardian sign)

Relson Gracie Jiu-Jitsu Academy Waiver of Claims and Liability

All students must sign this waiver of claims and liability. By signing this waiver of claims and liability, the student, parent or guardian acknowledges that they have read this agreement and will abide by all the rules of Relson Gracie Jiu-Jitsu Academy. Signing this waiver also means that the undersigned/student releases Relson Gracie Jiu-Jitsu Academy, Michael Key and all instructors from any liability in the case of injury or death from the instruction at Relson Gracie Jiu-Jitsu Academy. In consideration of being allowed to attend this Brazilian Jiu-Jitsu/Grappling/Self Defense/Kid’s Class/Boxing, the undersigned/student acknowledges that Brazilian Jiu-Jitsu/Grappling/Self Defense/Kid’s Class/Boxing are physical activities and that participation may result in serious injury including death, and other damage, due not only to the undersigned/student’s action, inaction or negligence, but also to that of the other associated with or present at these or other classes. Furthermore, I acknowledge that there may be risks not known to me and or not reasonably foreseeable at this time. I personally, totally and completely assume all risks involved or in any way related to my participation in this Brazilian Jiu-Jitsu/Grappling/Self Defense/Kid’s Class/Boxing whether known or unknown to me at the present time. Participation in this Brazilian Jiu-Jitsu/Grappling/Self Defense/Kid’s Class/Boxing is voluntary and entirely of my own free will. I hereby represent and certify that I am in good physical condition, and have no diseases, injuries, or other physical or mental that would impair my ability to participate in the Brazilian Jiu-Jitsu/Grappling/Self Defense/Kid’s Class/Boxing. The undersigned/student, heirs, executors and successors hereby waive claim of accident and or negligent damages or injury against Relson Gracie Jiu-Jitsu Academy, Michael Key, its instructors and any physical location where Relson Gracie Jiu-Jitsu Academy is taught. The undersigned/student also certifies that they are/will be covered by a medical insurance plan and will assume responsibility for all bills/costs associated with injuries sustained while attending or participating in Relson Gracie Jiu-Jitsu Academy class or seminar.