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ADULT WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT

MARTIAL ARTS, COMBAT SPORTS, AND FITNESS ACTIVITIES

GRACIE BARRA CLERMONT

BJJ CLERMONT, LLC

16215 S.R. 50, Suite 208, Clermont FL, 34711

Note: While our business name includes "BJJ," this facility offers multiple martial arts and combat sports. This waiver covers ALL activities at our facility, not just Brazilian Jiu-Jitsu.

PARTICIPANT INFORMATION

First Name *

Last Name *

Date of Birth *

Email Address * Please enter a valid email address

Confirm Email * Emails do not match

Phone Number * Format: 352-555-1234

Confirm Phone * Phone numbers do not match

State ID/Driver's License Number * Enter your state-issued ID or driver's license number

Street Address *

City *

State *

ZIP Code *

Emergency Contact Name *

Emergency Phone * Format: 352-555-1234

MEDICAL FITNESS & AUTHORIZATION

I certify that I am physically fit and mentally capable of participating in strenuous martial arts training, have no medical condition that would prevent my safe participation, and I will immediately inform BJJ Clermont, LLC if my health status changes.

In the event of a medical emergency, and by checking the box below, I grant the following specific authorizations:

I authorize BJJ Clermont, LLC staff to administer basic first aid to me.
I authorize certified staff to perform CPR and/or use an AED on me if deemed necessary.
I authorize staff to seek emergency medical treatment on my behalf if I am unable to communicate.
I authorize the sharing of necessary medical information with first responders.
I understand BJJ Clermont, LLC does not provide health insurance.
I agree to be financially responsible for all medical costs incurred.

I have read, understand, and agree to all statements in the Medical Fitness & Authorization section.

ACTIVITIES COVERED BY THIS WAIVER

This waiver covers participation in ALL current and future programs offered by BJJ CLERMONT, LLC, including but not limited to:

Brazilian Jiu-Jitsu (BJJ/GI and No-GI)
Muay Thai and Thai Boxing
Boxing and Kickboxing
Mixed Martial Arts (MMA)
Wrestling and Grappling
Self-Defense Programs
Martial Arts Fitness and Conditioning
Seminars, Workshops, and Special Events
Any New Programs Added in the Future

I have read and understand that this waiver covers ALL activities at this facility.

DESCRIPTION OF MARTIAL ARTS AND COMBAT SPORTS RISKS

I understand that participation in martial arts and combat sports involves significant risks, including but not limited to:

Striking injuries (concussions, broken bones)
Grappling injuries (joint dislocations, torn ligaments)
Chokes and strangulation techniques
Throws and takedowns resulting in impact injuries
Head injuries (concussions, TBI) and potential long-term effects
Dental and eye injuries
Broken bones and fractures
Skin infections (MRSA, ringworm, staph)
Spinal injuries, including potential paralysis
Cardiovascular stress (heart attack, stroke)
Death

This list is not exhaustive.

I have read and understand all the risks listed above.

NOTICE OF INHERENT DANGER

READ THIS SECTION COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO ENGAGE IN POTENTIALLY DANGEROUS ACTIVITIES. YOU ARE AGREEING THAT, EVEN IF BJJ CLERMONT, LLC USES REASONABLE CARE, THERE IS A CHANCE YOU MAY BE SERIOUSLY INJURED OR KILLED BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR RIGHT TO RECOVER FROM BJJ CLERMONT, LLC IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND BJJ CLERMONT, LLC HAS THE RIGHT TO REFUSE TO LET YOU PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I have read and understand the Notice of Inherent Danger above.

WAIVER OF LIABILITY FOR DEATH OR INJURY

IN CONSIDERATION OF BEING PERMITTED TO PARTICIPATE, I AGREE FOR MYSELF AND MY HEIRS, SUCCESSORS, AND ASSIGNS, TO FOREVER RELEASE, WAIVE AND DISCHARGE BJJ CLERMONT, LLC AND ALL ITS OFFICERS, AGENTS, AND AFFILIATES FROM ALL LIABILITY FOR ANY AND ALL LOSS ON ACCOUNT OF DEATH OR INJURY TO MY PERSON OR PROPERTY, WHETHER CAUSED BY NEGLIGENCE OR OTHERWISE, WHILE PARTICIPATING IN ANY ACTIVITIES AT BJJ CLERMONT, LLC.

I UNDERSTAND THAT I AM GIVING UP ANY RIGHT I MAY HAVE TO RECOVER FROM BJJ CLERMONT, LLC IN A LAWSUIT FOR NEGLIGENCE. I ASSUME FULL RESPONSIBILITY FOR THE RISK OF BODILY INJURY, DEATH, OR PROPERTY DAMAGE.

I have read and agree to the Waiver of Liability terms above.

INDEMNIFICATION

I agree to indemnify, defend, and hold harmless BJJ Clermont, LLC from any and all claims, demands, and costs (including attorney's fees) brought by any third party arising from my participation, including claims brought by training partners I may injure.

I have read and agree to the Indemnification terms above.

SAFETY, RULES & EQUIPMENT AGREEMENTS

Rules & Conduct: I agree to follow all gym rules and instructor directions, control my intensity, "tap out" early, and never intentionally injure a training partner. I understand failure to follow rules may result in dismissal without refund.

Equipment: I agree to inspect equipment before use and report defects. I will use appropriate protective equipment as required.

Health: I will not train if I have a communicable disease or skin infection.

Security Cameras: I acknowledge that the facility is monitored by security cameras for safety and security purposes, and I consent to being recorded by them.

I have read and agree to all safety, rules, and equipment terms above.

SPARRING AND LIVE TRAINING CONSENT

I understand that sparring and live training involve direct, full-contact with a resisting partner and significantly increase injury risk. I voluntarily choose to participate and understand I can decline at any time.

I have read, understand, and agree to the sparring and live training terms.

PHOTOGRAPHY AND MEDIA RELEASE

I understand that BJJ CLERMONT, LLC may take photographs and videos of classes and events for promotional purposes. Please select one of the following options:

I CONSENT to being photographed and/or recorded, and I authorize BJJ CLERMONT, LLC to use my likeness in promotional materials.

I DO NOT CONSENT to my likeness being used in promotional materials.

LEGAL PROVISIONS

Dispute Resolution: Any dispute arising from this agreement shall be resolved through binding arbitration in Lake County, Florida. I waive any right to a jury trial.

Additional Terms: This agreement is governed by Florida law. If any provision is invalid, the others remain in effect. This waiver is valid for all future visits unless I revoke it in writing.

I have read and agree to all legal provisions above.

FINAL ACKNOWLEDGMENTS AND SIGNATURE

By signing below, I acknowledge that:

I have read this entire document carefully.
I understand I am giving up substantial legal rights, including the right to sue.
I am at least 18 years old and signing this freely and voluntarily.
This is a legally binding contract.

I have read, acknowledge, and agree to all statements above.

ELECTRONIC SIGNATURE

By typing my full name below, I acknowledge that this constitutes my legal electronic signature.

Full Legal Name (Type Your Name) *

Today's Date

March 2, 2026

Draw Your Signature *

Use your mouse, finger, or stylus to sign below:

I affirm the above is my signature made voluntarily.

System Verification:

I confirm that I am the person identified above and that all information provided is accurate.

By clicking "Submit Waiver" below, you are electronically signing this waiver and agreeing to all terms and conditions.