Signup

STUDENT HEALTH & LIABILITY WAIVER

Participant Information (System Auto-fill) Name: {name} Date of Birth: {dob} Phone: {phone}

Emergency Contact Name: {contact_name} Phone: {contact_phone} Relation: {contact_relation}

1. HEALTH QUESTIONNAIRE

Please answer honestly. Your safety and the safety of your training partners depend on it.

Medical History Do you currently have, or have you ever suffered from any of the following? (Select all that apply) Heart Condition / Murmur / Stroke Asthma / Respiratory Issues Epilepsy / Seizures Joint / Bone / Spinal Injuries Arthritis Diabetes High Blood Pressure Migraines / Dizzy Spells Skin Infections (Ringworm, Staph, etc.) None of the above

Current Status Do you have any current injuries, physical limitations, or are you recovering from surgery? Yes No

Are you currently taking any regular medication that may affect your training? Yes No

(Females Only) Are you pregnant or suspect you might be? Yes No

Details If you answered YES to any question above, please provide details here:

2. WAIVER & RELEASE OF LIABILITY

Assumption of Risk I acknowledge that Brazilian Jiu-Jitsu (BJJ) is a full-contact martial art involving grappling, throws, joint locks, and chokes. I understand that participation carries inherent risks, including but not limited to: scratches, bruises, sprains, fractures, joint injuries, and in rare cases, serious injury. I voluntarily accept these risks.

Health & Hygiene Declaration

• I confirm that I am physically fit to participate.

• I agree not to train if I have any contagious skin condition (e.g., Ringworm, Staph, Herpes) or viral illness (Flu/Covid).

• I understand that training while knowingly contagious is grounds for immediate suspension.

Release of Liability To the extent permitted by law, I release and hold harmless Garra Brazilian Jiu-Jitsu Academy, its owners, instructors, and staff from any liability for injury, loss, or damage arising from my participation in classes, sparring, or use of the facilities.

Medical Authorization In the event of an emergency where I (or my emergency contact) cannot be reached, I authorize academy staff to obtain necessary medical treatment, including calling an ambulance. I accept responsibility for any associated medical costs.

3. DECLARATION & SIGNATURE

I have read and understood this Waiver & Health Questionnaire. I declare that the medical information provided is accurate and I agree to the terms of liability release.

(If participant is under 18, a Parent/Guardian must sign)

Signed by: Date: {sign_date}