Ultimate Athlete
Jiu Jitsu · Modesto, CA
Liability Waiver
Read the agreement below, fill in your details, and sign.
Release, Indemnification & Covenant Not to Sue
In consideration of my participation in American Jiu Jitsu, Wrestling, Weightlifting, Cardio, and Infrared Sauna use, I, the undersigned participant, knowingly and voluntarily agrees to release and on behalf of myself, any participating or non-participating children under my supervision, my heirs, representatives, executors, administrators, and assigns, HEREBY DO RELEASE Company, its officers, directors, employees, volunteers, agents, representatives and insurers ("Releasees") from any causes of action, claims, or demands of any nature whatsoever including, but in no way limited to, claims of negligence, which I, my heirs, representatives, executors, administrators and assigns may have, now or in the future, against Company on account of personal injury, property damage, death or accident of any kind, arising out of or in any way related to the use of Company facilities/equipment or participation in Company programs whether that participation is supervised or unsupervised, however the injury or damage occurs, including, but not limited to the negligence of Releasees. THE UNDERSIGNED HEREBY ASSUMES FULL RESPONSIBILITY FOR, AND RISK OF ILLNESS, BODILY INJURY, DEATH OR PROPERTY DAMAGE to the undersigned or such participating children due to negligence, active or passive, or otherwise while in, about or upon the premises of Company and/or while using the premises or any facilities or equipment thereon or participating in any program affiliated with Company The undersigned acknowledges that any illness or injuries that the undersigned or such participating children contract or sustain may be compounded by negligent first aid or emergency response of the Releasees and waive any claim in respect thereof.
In consideration of my participation in Company programing or access to facilities, I, the undersigned participant, agree to INDEMNIFY, DEFEND, AND HOLD HARMLESS Releasees from any and all causes of action, claims, demands, losses, or costs of any nature whatsoever arising out of or in any way related to my program participation or access to facilities. I hereby certify that I have full knowledge of the nature and extent of the risks inherent in fitness program participation and facility use and that I am voluntarily assuming said risks. I understand that I will be solely responsible for any loss or damage, including personal injury, property damage, or death, I sustain while participating in Company programing or facility use and that by signing this agreement, I HEREBY RELEASE Releasees from all liability for such loss, damage, or death. I further certify that I am in good health and that I have no conditions or impairments which would preclude my safe participation in Company programming or facility use.
I {FirstName} {LastName} HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM COMPANY IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, AND NOT LIMITED TO, EXPOSURE TO COVID-19 AT ANY COMPANY FACILITY OR PROGRAM AND ANY ILLNESS, INJURY OR DEATH RESULTING FROM PARTICIPATIOIN in COMPANY'S PROGRAMS . I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE to INDEMNIFY, DEFEND, AND HOLD HARMLESS FOR ALL CLAIMS. IF SIGNING ON BEHALF OF MINOR: I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT TO COMPANY THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S). BY SIGNING THIS AGREEMENT I UNDERSTAND THAT THIS IS AGREEMENT IS ALSO MADE ON BEHALF OF ANY MINOR I BRING INTO THE FACILITY AND I REPRESENT AND WARRANT TO COMPANY THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S) AND IF I DO NOT, I WILL NOT BRING IN SUCH MINOR INTO THE FACILITY.
Member Safety Screening
MEMBER SAFETY SCREENING CONSENT: For the safety of all members, students, and staff — including minors — Ultimate Athlete Jiu Jitsu may verify the information provided in this waiver against publicly available sex offender registries and other public safety databases. By submitting this waiver, I voluntarily consent to this verification. Any ID photo provided is used solely for identity verification and safety screening purposes, is accessible only to authorized gym staff, and is retained only as long as necessary for safety purposes. This screening is a condition of participation.
