In consideration of adult/child named below permitted to participate in activities and events
under the supervision of PREVAIL JIU JITSU, the undersigned acknowledges, understands and
agrees to the following.
1. The risk of injuries and or illness from activities involved in Jiu Jitsu is significant, including the
potential for permanent paralysis and death. While particular rules, equipment, and personal
discipline may reduce the risk. The risk of serious injury does exist.
2. The risk to have direct or indirect contact with individuals who have been exposed to or
diagnosed with a communicable disease, including but not limited to COVID-19 or other medical
conditions, diseases, maladies, or variations thereof, does exist and its is impossible to
eliminate the risk that this child/adult could become infected through contact with or close
proximity to an individual with a communicable disease. I understand that it is my responsibility
to constantly take my athlete’s temperature before all academy activities and will keep them
from participating if said temperature is deemed too high by all CDC Covid-19 suggestions and
requirements. I also understand that my athlete must have his/her PPE items including but not
limited to masks, hand sanitizer, and cleaning wipes which should be used frequently during all
training and academy activities.
3. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and
assume full responsibility for this child/adult’s participation in Jiu Jitsu.
4. I willingly agree to comply with the stated and customary terms and conditions for
participation. If, however, I observe an unusual, significant and hazard during my presence at
activities and or events under the supervision of PREVAIL JIU JITSU, this child/adult will
discontinue participation and myself and child/adult will bring such hazard to the attention of the
nearest official immediately.
5. This child/adult, and his/her parents on behalf of my/our heirs, assigns, personnel
representatives, and next of kin. HEREBY RELEASE AND HOLD HARMLESS PREVAIL JIU
JITSU, their officers, officials, agents, employees, volunteers, participants, sponsoring agents,
sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the
events (RELEASEES) WITH RESPECT TO ANY AND ALL ILLNESS, DISABILITY, DEATH, or
loss or damage to person or property, to this child/adult, to the fullest extent permitted by law.
6. By participating in or attending any activity in connection with this business, whether on or off
the premises, I consent to the use of any photographs, pictures, film or videotape taken of me or
provided by me for publicity, promotion, television, websites or any other use, and expressly
waive any right of privacy, compensation, copyright or other ownership right connected to same.
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT,
FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL
RIGHTS BY SIGNING IT, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT AND
INDUCEMENT.
- {name} - Full name
- {dob} - Date of birth
- {contact_name} - Emergency contact
- {contact_relation} - Emergency contact relation
- {contact_phone} - Emergency contact phone
FOR PARENT(S) OR GUARDIANS OF MINORITY AGE YOUTH PARTICIPANTS
This is to clarify that I, as a parent/guardian, with legal responsibility for this participant, have
read and explained the provisions in this waiver/release to my child/ward including the risks of
presence and participation and his/her personnel responsibilities for adhering to the rules and
regulations for protection against injuries and illnesses (including communicable diseases).
Furthermore, my/our child/ward understands and accepts these risks and responsibilities. I for
myself and other parent, and child/ward do consent and agree to his/her release provided above
for all the releases. I, the other parent and my/our child’s/ward’s presence of participation in
PREVAIL JIU JITSU activities as provided above, to the fullest extent provided by law.
- - Name of the member or guardian signing the document (if applicable)
- {sign_date} - Date document was signed (if applicable)
THIS RELEASE/WAIVER IS IN COMPLIANCE WITH MCL 700.5109
Prevail Jiu Jitsu
