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}
Fifth Element Academy
