Participant Name:
Date of Birth:
Address: City: State: Zip:
Statement of Medical Fitness and Insurance Coverage
By signing below, I/We affirm that I and/or my child does not have any conditions which would affect my and/or my child’s mental or physical ability to train/participate. By signing below, I/We affirm that I/We have consulted with my/our medical physician and confirmed my or my child’s mental and physical fitness to train/participate. I also have medical coverage for any loss.
Participant/Guardian Signature:
Photo/Video Consent
By signing below, I give permission for myself and/or my child to be photograph and/or videotape which will be used by Team Carvalho Academy and Dunnellon Martial Arts & Fitness. I understand that pictures and/or videos will be used on the World Wide Web at www.teamcarvalho.com, and/or all our social media and any advertising. I understand that it can be seen throughout the world.
Participant/Guardian Signature:
Dunnellon Martial Arts & Fitness Carvalho Judo and Brazilian Jiu-Jitsu Academy Release and Waiver of Liability & Indemnity Agreement (Read Carefully Before Signing)
In consideration of being permitted to participate in any way in the Martial Arts of Judo/Brazilian Jiu-Jitsu/SelfDefense/Kickboxing/Fitness Training Program indicated below and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant in the below agree:
1. The parent(s) and/or legal guardian(s) will instruct the minor participant that prior to participating in the below Martial Arts of Judo/Brazilian Jiu-Jitsu/Self-Defense/Kickboxing/Fitness Training activity or event, he or she should inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant should immediately advise the officials of such condition and refuse to participate. I understand and agree that, if at any time, I feel anything to be UNSAFE, I will immediately take all precautions to avoid the unsafe area and REFUSE TO PARTICIPATE further.
2. I/We fully acknowledge that: (a) There are risks and dangers associated with participation in Martial Arts of Judo/Brazilian JiuJitsu/Self-Defense/Kickboxing/Fitness training/events and activities which could result in bodily injury partial and/or total disability, paralysis, and death. (b) The social and economic losses and/or damages, which could result from these risks and dangers described above, could be severe. (c) These risks and dangers may be caused by the actions, inaction, or negligence of the participant or the action, inaction or negligence of others, including but not limited to, the Releases named below.
3. I/We accept and assume such risks and responsibility for the loses and/or damages following such injury, disability, paralysis, or death, however caused and whether caused in whole or in part by the negligence of the Releasees named below.
4. I/We HEREBY RELEASE , WAIVE, DISCHARGE AND CONVENANT NOT TO SUE Carvalho Judo and Brazilian Jiu-Jitsu Academy and/or Dunnellon Martial Arts & Fitness including its owners, managers, promoters, lessees of premises used to conduct the Martial Arts of Judo/Brazilian Jiu-Jitsu/Self-Defense/Kickboxing/Fitness Training Program or event, premises and event inspectors, underwriters, consultants and others who give recommendations, directions, or instructions to engage in risk evaluation or loss control activities regarding the Martial Arts of Judo/Brazilian Jiu-Jitsu/Self-Defense/Kickboxing/Fitness Training Program facility or events held at such facility and each of them, their directors, officers., agents, employees, all for the purposes herein referred to as “Releasee” FROM ALL LIABILITY TO THE UNDERSIGNED, my/our personal representatives, assigns, executors, heirs, kin, FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES OR DAMAGES AND ANY CLAIMS OR DEMAGE TO PROPERTY, ARISING OUT OF OR RELATING TO THE EVENT(S) CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEEASEE OR OTHERWISE.
5. I/We HEREBY acknowledge that THE ACTIVITIES OF THE EVENT(S) ARE VERY DANGEROUS and involves the risks of serious injury and/or death and/or property damage. Each of the UNDERSIGNED also expressly acknowledges that INJURIES RECEIVED MAY BE COMPOUNDED OR INCREASED BY NEGLIGENT RESCUE OR PROCEDURES OF THE RELEASEES.
6. EACH OF THE UNDERSIGNED further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Providence or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect.
I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTANDING ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.
Location: Dunnellon Martial Arts & Fitness, Carvalho Judo & BJJ Academy, 20751 Powell Road, Dunnellon, FL 34431
Participant (Print Name):
Participant’s Signature:
FOR PARENTS/GUARDIANS OF PARTICIPANTS OF MINORITY AGE (UNDER AGE 18 AT TIME OF REGISTRATION)
Parent/Guardian (Print Name):
Parent’s/Guardian’s Signature:
Welcome to Carvalho Judo & Brazilian Jiu-Jitsu Academy
Rules & Code of Ethics
◇ Respect your Instructor and other Participants
◇ Bow when entering or leaving the mats.
◇ No bare feet off the mat. Shoes must be worn to and from the mat. Bring your own
sandals.
·◇ Clip your toe and fingernails and take care of your hygiene.
◇ Wear a clean Gi (uniform).
◇ No food or drink on the mat.
◇ No food in dojo or gym.
◇ No jewelry to be worn during training.
◇ No foul language.
◇ Don't miss a warm-up, it improves your endurance and prevents injury.
◇ Late arrivals must stand on the side until the Instructor allows them to join the class.
◇ No unsupervised children outside of seating area.
◇ No personal items/gym bags on floor. Must be placed on shelf.
◇ Shirts required at all times
◇Dress code women: Midriff covered, No short shorts.
◇ All participants are to contribute to a positive and rewarding experience for all participants. This includes the following responsibilities: Safety, Sportsmanship, Respect, Nondiscrimination, Honesty, Orderly Behavior, Loyalty, Lawful Conduct, Fairness and Proper use of influenced position.
Welcome to Team Carvalho We look forward to helping you achieve your goals.
Have a great time!
Team Carvalho Academy, 20751 Powell Road, Dunnellon, FL 34431 844-Judobjj
Visit us at www.teamcarvalho.com - Facebook: Carvalho Judo BJJ