Schedule

KAIZEN JIU JITSU LIABILITY WAIVER AND RELEASE AGREEMENT

Gym Name: Kaizen Jiu Jitsu

Address: 618 Ashlawn St SW. Unit B,  Roanoke, Va. 24015

Phone: 540819-0805

Email: info@kaizenbjjroanoke.com

This Liability Waiver and Release Agreement is entered into by and between Kaizen Jiu Jitsu , its owners, instructors, employees, agents, and affiliates, and the undersigned participant , or if the Participant is a minor, their parent or legal guardian.

1. Acknowledgment of Risk

I, , understand and acknowledge that participating in Brazilian Jiu-Jitsu (BJJ), martial arts, and fitness training at Kaizen Jiu Jitsu involves inherent risks, including but not limited to:

• Physical injury (sprains, fractures, dislocations, cuts, bruises, concussions, paralysis, or death)
• Risks of transmission of illness or disease
• Contact with other participants that may lead to accidental harm
• The possibility of equipment malfunction or failure

I further acknowledge that Kaizen Jiu Jitsu takes reasonable precautions to ensure participant safety, but injuries and accidents may still occur.

2. Assumption of Risk

I voluntarily choose to participate in activities at Kaizen Jiu Jitsu and assume all risks associated with my participation, whether known or unknown, including those arising from negligence.

3. Release of Liability

I hereby release, discharge, and agree to hold harmless Kaizen Jiu Jitsu, its owners, instructors, employees, agents, sponsors, and affiliates from any and all claims, demands, liabilities, costs, or expenses (including legal fees) arising from injury, illness, damage, or death that may occur as a result of participation in training, competition, or events.  Furthermore, I also release, discharge, and agree to hold harmless the above mentioned if I bring a minor, who is not a member, into the facility and they get injured.  I understand any minor I bring is my responsibility solely.

4. Medical Treatment and Insurance

I understand that Kaizen Jiu Jitsu does not provide medical insurance or coverage. In the event of injury, I authorize Kaizen Jiu Jitsu staff to obtain emergency medical treatment for me (or my minor child), and I accept full financial responsibility for any costs incurred.

5. Fitness to Participate

I certify that I (or my minor child) am physically fit and have no known medical conditions or impairments that would prevent safe participation in BJJ or fitness training. If I have any medical concerns, I have consulted a physician before participating.

6. Photography & Media Release

I grant Kaizen Jiu Jitsu full permission to use any photographs, videos, or other media taken during training, competitions, or events for promotional, educational, or marketing purposes. I understand that these materials may be used in social media, advertising, website content, and other forms of public distribution without compensation or prior approval.

7. Code of Conduct

I agree to follow all gym rules, respect instructors and fellow participants, and conduct myself in a safe and respectful manner. Failure to comply may result in suspension or termination of my gym membership without refund.

8. Minor Participant Agreement (If Applicable)

If signing on behalf of a minor participant, I affirm that I am the parent or legal guardian, and I consent to my child’s participation under the terms of this waiver.

9. Governing Law & Severability

This Agreement shall be governed by the laws of the state of Virginia. If any provision of this Agreement is found to be invalid, the remaining provisions shall remain enforceable.

Acknowledgment and Signature

By signing below, I acknowledge that I have read, understood, and voluntarily agreed to this Liability Waiver and Release Agreement. I understand that I am waiving certain legal rights, including the right to sue.

Participant’s Name:

Date of Birth:

Phone Number:

Email: {email}

Signature of Participant:

Date: 06/26/2025

Parent/Guardian Name (if applicable):

Signature of Parent/Guardian:

Date: 06/26/2025