Starting June 1st

ADULT PARTICIPANT WAIVER AND RELEASE OF LIABILITY

Academy Name: Fifth Element Academy (Doing Business As under JED Martial Arts, LLC)

Location: Greenwich, Connecticut

Activities: Brazilian Jiu-Jitsu (BJJ), grappling, self-defense, conditioning, strength training, open mat training, seminars, competitions, demonstrations, special events, and use of academy premises and equipment

1. CLEAR AND UNAMBIGUOUS ACKNOWLEDGMENT OF RISK (CONNECTICUT STANDARD)

I understand and expressly acknowledge that Brazilian Jiu-Jitsu is a strenuous contact sport involving intentional physical contact. Injuries are common and may include, but are not limited to: cuts, bruises, strains, sprains, joint injuries, broken bones, dislocations, loss of consciousness, concussions, paralysis, permanent disability, or death. I understand that these risks exist regardless of the care, supervision, or instruction provided by the academy or its staff.

2. VOLUNTARY PARTICIPATION AND FITNESS TO PARTICIPATE

I voluntarily elect to participate and represent that I am physically and mentally fit to engage in all academy activities. I certify that I have disclosed any medical conditions, injuries, or limitations that may affect my safe participation.

3. EXPRESS ASSUMPTION OF RISK

I knowingly, voluntarily, and expressly assume all risks of injury, loss, or damage arising out of my participation, whether known or unknown, foreseeable or unforeseeable, and whether arising from my own actions, the actions of others, or the condition of the premises.

4. RELEASE, WAIVER, AND COVENANT NOT TO SUE (INCLUDING NEGLIGENCE)

TO THE FULLEST EXTENT PERMITTED UNDER CONNECTICUT LAW, I HEREBY EXPRESSLY RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Fifth Element Academy, JED Martial Arts, LLC, and their owners, officers, instructors, coaches, employees, volunteers, independent contractors, landlords, and agents (collectively, the “Released Parties”) FROM ANY AND ALL CLAIMS, DEMANDS, OR CAUSES OF ACTION FOR PERSONAL INJURY, PROPERTY DAMAGE, OR WRONGFUL DEATH, INCLUDING CLAIMS ARISING FROM THE NEGLIGENCE OF THE RELEASED PARTIES.

5. INDEMNIFICATION

I agree to indemnify and hold harmless the Released Parties from any claim, loss, liability, or expense, including attorney’s fees, arising from or related to my participation.

6. MEMBERSHIP TERMS, AUTO-RENEWAL, AND BILLING RESPONSIBILITY

I understand that participation may be subject to an ongoing membership agreement, including auto-renewal billing, payment obligations, cancellation requirements, and applicable fees as disclosed separately by the academy. I acknowledge that failure to attend classes or events does not relieve me of financial responsibility.

7. EMERGENCY CONTACT AND MEDICAL DISCLOSURE

Emergency Contact Name: {contact_name} 

Relationship: {contact_relation}

Phone Number: {contact_phone}

Please list any medical conditions, injuries, allergies, medications, or physical limitations:

8. MEDICAL AUTHORIZATION

In the event of an emergency, I authorize the academy to obtain medical treatment on my behalf if I am unable to consent. I accept full financial responsibility for any medical care provided.

9. PHOTOGRAPHY & MEDIA RELEASE

I grant permission for photographs or video recordings taken during training or events to be used for promotional, marketing, or educational purposes without compensation.

10. GOVERNING LAW AND VENUE

This agreement shall be governed by and interpreted in accordance with the laws of the State of Connecticut. Venue for any legal action shall lie exclusively within the courts of the State of Connecticut.

11. SCOPE OF AGREEMENT

This waiver applies to all participation, including ongoing memberships, trial or introductory classes, private lessons, group classes, open mats, seminars, competitions, special events, demonstrations, travel related to events, and use of academy facilities.

12. SEVERABILITY

If any provision of this agreement is found unenforceable, the remaining provisions shall continue in full force and effect.

Participant Full Name (Print):

Signature: 

Date: {sign_date}

MINOR (CHILD) PARTICIPANT WAIVER AND PARENT/GUARDIAN RELEASE

Academy Name: Fifth Element Academy (Doing Business As under JED Martial Arts, LLC)

Location: Greenwich, Connecticut

Activities: Brazilian Jiu-Jitsu (BJJ), grappling, self-defense, conditioning, strength training, open mat training, seminars,

competitions, demonstrations, special events, and use of academy premises and equipment

1. MINOR PARTICIPANT INFORMATION

Child’s Full Name: {name}

Date of Birth: {dob}

2. CLEAR ACKNOWLEDGMENT OF RISK

I understand that Brazilian Jiu-Jitsu is a contact sport involving inherent risks of injury, including serious bodily harm or death, even when conducted under supervision.

3. CONSENT AND ASSUMPTION OF RISK

I knowingly consent to my child’s participation and expressly assume all risks on behalf of my child to the fullest extent permitted by Connecticut law.

4. RELEASE AND WAIVER OF LIABILITY (INCLUDING NEGLIGENCE)

TO THE FULLEST EXTENT PERMITTED UNDER CONNECTICUT LAW, I EXPRESSLY RELEASE AND WAIVE ALL CLAIMS AGAINST Fifth Element Academy, JED Martial Arts, LLC, AND ALL RELEASED PARTIES, INCLUDING CLAIMS ARISING FROM THEIR NEGLIGENCE.

5. INDEMNIFICATION

I agree to indemnify and hold harmless the Released Parties from any claims or expenses arising from my child’s participation.

6. MEMBERSHIP TERMS AND BILLING RESPONSIBILITY

I understand that my child’s participation may be subject to an ongoing membership agreement with auto-renewal billing and cancellation requirements. Failure to attend does not eliminate payment responsibility.

7. EMERGENCY CONTACT AND MEDICAL DISCLOSURE

Emergency Contact Name: {contact_name}

Relationship: {contact_relation}

Phone Number: {contact_phone}

Medical conditions, injuries, allergies, medications, or limitations:

8. MEDICAL AUTHORIZATION

I authorize the academy to obtain emergency medical treatment for my child if I cannot be reached and accept financial responsibility for all related expenses.

9. PHOTOGRAPHY & MEDIA RELEASE

I grant permission for my child’s image or likeness to be used in photographs or video recordings for promotional, marketing, or educational purposes without compensation.

10. GOVERNING LAW AND VENUE

This agreement shall be governed by the laws of the State of Connecticut.

11. SCOPE OF AGREEMENT

This waiver applies to all participation including ongoing memberships, trial classes, seminars, competitions, special events, demonstrations, travel related to events, and use of academy premises.

12. SEVERABILITY

If any provision is found unenforceable, the remaining provisions shall remain valid.

Parent/Guardian Full Name (Print):

Relationship to Child:

Signature:

Date: {sign_date}