NexJen BJJ Injury Waiver & Release

Before starting this or any other exercise program, always consult your doctor. All students are required to provide their own medical coverage.

INJURY WAIVER

I hereby affirm that I am in good physical condition and do not suffer from any disability that would prevent or limit my participation in any classes taken at NexJen BJJ. I hereby release NexJen BJJ, its employees, owners, and participants from any claims, demands, and causes of action arising from my participation during any class at NexJen BJJ. I fully understand that I may injure myself and I hereby release NexJen BJJ, its owners, employees, and participants from any liability now or in the future, including, but not limited to pulls or tears (muscles, ligaments or tendons), muscle strains, broken bones, joint dislocations, hyper extensions of bones and joints, ankle, knee, hip, lower back, shoulder, elbow, wrist, finger or toe injuries, heart attacks, strokes, loss of vision, concussion, dental trauma, death, or any other injury or illness however caused, occurring during or after my participation in any class taken at NexJen BJJ.

WAIVER OF LIABILITY

I understand and agree that NexJen BJJ is not responsible for property that is lost, stolen, or damaged while in, on, or about the premises.

COMPLIANCE WITH RULES

I agree to comply with all rules imposed by NexJen BJJ regarding the use of the facilities and equipment. I agree to conduct myself in a controlled and reasonable manner at all times, and to refrain from using any equipment, training, or property in a manner inconsistent with its intended design and purpose. I hereby affirm that I have read fully, understand and agree with the above statements.

PHOTO/IMAGE RELEASE I hereby grant NexJen BJJ and its agents permission to use photographic portraits, pictures, digital images or videotapes of me and/or my minor child, or in which I/they may be included in whole or part, or reproductions thereof in color or otherwise for any lawful purpose whatsoever, including but not limited to use in any NexJen BJJ publication or on the NexJen BJJ website, without payment or any other consideration. I hereby waive any right that I may have to inspect and/or approve the finished product or the copy that may be used in connection therewith, wherein my likeness appears, or the use to which it may be applied. On behalf of myself, my heirs, representatives, executors, and assigns, I hereby release, discharge, and agree to indemnify and hold harmless NexJen BJJ and its agents from all claims, demands, and causes of action that I have or may have by reason of this authorization, including any liability by virtue of any blurring, distortion, alteration, optical illusion, or use in composite form, whether intentional or otherwise, that may occur or be produced in the taking of said photos or videotapes, or in processing tending towards the completion of the finished product.

I understand the conditions of this waiver and release will remain in effect until I revoke them in writing. Submission of this form is my confirmation that I am signing this agreement on my own behalf or as the parent or legal guardian of the minor listed below.

Participant First Name

Participant Last Name

Is the participant under the age of 18?

Yes

Primary Contact Email:

Primary Contact Phone Number:

Additional Emergency Contact Name:

Relationship to Participant:

Emergency Contact Phone:

Signature of Participant or Parent/Legal Guardian:

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