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MINOR WAIVER, RELEASE, AND INDEMNIFICATION AGREEMENT

MARTIAL ARTS, COMBAT SPORTS, AND FITNESS ACTIVITIES

FOR PARTICIPANTS UNDER 18 YEARS OF AGE

GRACIE BARRA CLERMONT

BJJ CLERMONT, LLC

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

Note: This waiver is for participants under 18 years of age. A parent or legal guardian must complete and sign this form. 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.

MINOR PARTICIPANT INFORMATION

Minor's First Name *

Minor's Last Name *

Minor's Date of Birth *

Gender

Minor's Street Address *

City *

State *

ZIP Code *

Emergency Contact Name *

Emergency Phone * Format: 352-555-1234

Emergency Contact Relationship *

PARENT/GUARDIAN INFORMATION

Parent/Guardian First Name *

Parent/Guardian Last Name *

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

Relationship to Minor *

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

Parent's Street Address *

City *

State *

ZIP Code *

MEDICAL INFORMATION & AUTHORIZATION

The minor participant's parent/guardian certifies that the minor is physically fit and mentally capable of participating in strenuous martial arts training, has no medical condition that would prevent safe participation, and will immediately inform BJJ Clermont, LLC if the minor's health status changes.

In the event of a medical emergency, and by checking the box below, the parent/guardian grants the following specific authorizations:

Authorize BJJ Clermont, LLC staff to administer basic first aid to the minor.
Authorize certified staff to perform CPR and/or use an AED on the minor if deemed necessary.
Authorize staff to seek emergency medical treatment on the minor's behalf if unable to contact parent/guardian.
Authorize the sharing of necessary medical information with first responders.
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 Information & Authorization section above.

ACTIVITIES COVERED BY THIS WAIVER

This waiver covers my child's participation in ALL current and future youth and teen programs offered by BJJ CLERMONT, LLC, including but not limited to:

Brazilian Jiu-Jitsu (BJJ/GI and No-GI)
Kids and Teen Martial Arts Programs
Muay Thai, Boxing, and Kickboxing
Wrestling and Grappling
Self-Defense and Anti-Bullying Programs
Martial Arts Fitness and Conditioning
Seminars, Workshops, and Special Events
Competitions and Tournament Preparation
Supervised Open Mat Sessions
Summer Camps and After-School Programs
Any New Programs Added in the Future

I have read and understand that this waiver covers ALL activities my child may participate in.

DESCRIPTION OF MARTIAL ARTS AND COMBAT SPORTS RISKS

I understand that my minor child will be exposed to 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, fractures, and growth plate injuries
Skin infections (MRSA, ringworm, staph)
Cuts, bruises, abrasions, and permanent scarring
Spinal injuries, including potential paralysis
Injuries from training with partners of different ages, sizes, and skill levels
Psychological stress from physical confrontation and competition
Death

This list is not exhaustive.

I have read and understand all the risks my child may face as listed above.

NOTICE OF INHERENT DANGER (FOR MINOR PARTICIPANT)

NOTICE OF INHERENT DANGER

READ THIS SECTION COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN POTENTIALLY DANGEROUS ACTIVITIES. YOU ARE AGREEING THAT, EVEN IF BJJ CLERMONT, LLC USES REASONABLE CARE, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE GIVING UP YOUR CHILD'S RIGHT AND 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 YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

I have read and understand the Notice of Inherent Danger on behalf of my child.

WAIVER OF LIABILITY FOR DEATH OR INJURY

IN CONSIDERATION OF MY MINOR CHILD BEING PERMITTED TO PARTICIPATE, I AGREE FOR MYSELF, MY MINOR CHILD, AND OUR HEIRS, SUCCESSORS, AND ASSIGNS, TO FOREVER RELEASE, WAIVE AND DISCHARGE BJJ CLERMONT, LLC AND ALL ITS OFFICERS, AGENTS, EMPLOYEES, AND AFFILIATES FROM ALL LIABILITY FOR ANY AND ALL LOSS ON ACCOUNT OF DEATH OR INJURY TO MY CHILD'S 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 OR MY CHILD 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 TO MY CHILD.

I have read and agree to the Waiver of Liability terms on behalf of myself and my minor child.

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 child's participation, including claims brought by other participants injured by my child or by my child upon reaching the age of majority.

I have read and agree to the Indemnification terms above.

PARENTAL, YOUTH SAFETY & BEHAVIORAL AGREEMENTS

Rules & Conduct: I will instruct my child to follow all gym rules and instructor directions. I understand that bullying or aggressive behavior will not be tolerated and may result in dismissal without refund.

Supervision & Pick-Up: I understand the gym is only responsible for my child during scheduled class times. I agree to pick up my child promptly after class and will not drop them off more than 10 minutes early.

Health: I will not bring my child to train if they 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 my child being recorded by them.

I have read and agree to all parental, youth safety, and behavioral terms above.

SPARRING AND LIVE TRAINING CONSENT

I consent to my child participating in controlled sparring and live training that is appropriate for their age and skill level. I understand that this involves direct contact with resisting partners and significantly increases injury risk. I know that protective equipment is required but does not eliminate all risk.

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

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 my child being photographed and/or recorded, and I authorize BJJ Clermont, LLC to use my child's likeness in promotional materials.

I DO NOT CONSENT to my child's 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 for myself and my child 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 until my child turns 18 or I revoke it in writing.

I have read and agree to all legal provisions above.

PARENT/GUARDIAN FINAL ACKNOWLEDGMENTS

By signing below, I acknowledge that:

I have read this entire document carefully.
I understand I am giving up substantial legal rights for myself and my child, including the right to sue.
I am the legal parent or guardian with the authority to sign on behalf of this minor.
I am signing this freely and voluntarily.
This is a legally binding contract.

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

ELECTRONIC SIGNATURE - PARENT/GUARDIAN

By typing my full name below, I acknowledge that this constitutes my legal electronic signature and has the same legal force and effect as a handwritten signature.

Parent/Guardian 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.