STUDENT WAIVER/INDEMNITY FORM
WAIVER / RELEASE / ASSUMPTION OF RISK
PARTICIPANT NAME: {name}
PARENT/LEGAL GUARDIAN/STUDENT:
I understand and have had explained to me that the martial art known as “Gracie Jiu-Jitsu” is taught using precautions to avoid any injuries. However, participation in the Gracie Jiu-Jitsu classes carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks range from minor injuries such as scratches, bruises, and sprains, to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions, to catastrophic injuries including paralysis and death. Furthermore, I understand the practice of Gracie Jiu-Jitsu presents a risk of skin infections, communicable diseases, bacteria(s) and viruses.
I understand and have had explained to me that, along with the possibility of personal injury, injury to property is also possible, such as, but not limited to, possible loss of income and the ability to earn such income. With full knowledge of the aforementioned dangers, both to my person and to my property (current and future), and after having these dangers fully explained to myself and/or to my legal guardian, the identity of which is stated above, I nevertheless desire to participate in Gracie Jiu-Jitsu training and activities.
I hereby certify and declare that I will release and forever hold free and discharge from any liability Gracie Jiu-Jitsu Fourways CC (hereinafter referred to as “Gracie Jiu-Jitsu Fourways”), and each of their owners, agents, stockholders, directors, officers, employees and representatives of and from all claims, demands, rights and causes of action of any nature whatsoever which may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or other loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from my participation in Gracie Jiu-Jitsu, their persons and entities mentioned above, including and not limited to any negligence on the part of Gracie University, their owners, agents stockholders, directors, officers, employees, volunteers representatives.
Further, knowing and understanding these risks, nevertheless I hereby agree to voluntarily assume these risks and to release and hold harmless all the persons or entities mentioned above whom might otherwise be liable to me for damages. It is further understood that this waiver, release and assumption of risk is forever binding on my heirs, assigns, executors, administrators and representatives. I also understand and acknowledge that I have and will maintain appropriate medical insurance during classes/training.
I am also aware that for purposes of safety, security and quality control, there are surveillance cameras mounted throughout Gracie Jiu-Jitsu Fourways. Furthermore, I understand and acknowledge that video recording or photographs may be taken of me during classes/training. I hereby grant Gracie Jiu-Jitsu Fourways the unlimited use of my personal information, as defined in the Protection of Personal Information Act No. 4 of 2013, in any format photo, video, or other, for promotional advertisement or commercial use, in any format known or yet to be developed in perpetuity, and I forfeit any form of payment. It is further acknowledged that this personal information will be processed in accordance with Gracie Jiu-Jitsu Fourways’ Privacy Policy in compliance with the Popi Act. It is further understood that I will not video record or photograph any classes/training without prior permission from Gracie Jiu-Jitsu Fourways.
I hereby confirm that I have familiarized myself with the terms and conditions and the house rules and regulations of Gracie Jiu-Jitsu Fourways, and confirm that I understand same and am bound thereto.
I undertake to, at all times, adhere to the discipline and supervision of the gym management and instructors to ensure my own safety and that of other members.
I understand that Right of Admission into Gracie Jiu-Jitsu Fourways is reserved.
I understand that I may not lose my temper and or become violent towards members of Gracie Jiu-Jitsu Fourways inside or outside the sphere of competition or training, and that I will face immediate suspension if found guilty in acting in such a manner.
I understand that I may not at any stage enter Gracie Jiu-Jitsu Fourways whilst being under the influence of any substance of whatever nature, inclusive of alcohol and or drugs and or any substance of whatever nature. Suspension would follow immediately.
I undertake to always train only in accordance with the safety rules and suggestions presented to me. I understand and accept that intense physical and mental exertion may occur during the course of the training and therefore I further warrant that I have no medical or mental condition or complaints that in any way may endanger me or other clients during or after participation in the training.
I understand that in the event of injury, it does not disqualify me from paying my monthly membership fee unless one calendar month written notice has been submitted.
I understand that Gracie Jiu-Jitsu Fourways retains the right to cancel this agreement at any time with or without cause. I shall be entitled to a refund of all unearned amounts due upon cancellation by Gracie Jiu-Jitsu Fourways.
I understand that there is a monthly membership when joining Gracie Jiu-Jitsu Fourways, which is non-refundable, and payable monthly in advance.
I hereby agree to, when signing a monthly membership, sign a debit order authorisation form with the option to run the debit order on the 1st or 26th of every month for the duration of the signed contract.
As a Gracie Jiu-Jitsu Fourways student, we respect your privacy and protect your personal information. We share important updates via email or WhatsApp. According to the POPI Act, you can "Opt Out" of these communications, but you will miss essential updates like class calendars and newsletters.
I hereby confirm that Gracie Jiu-Jitsu Fourways may use my contact information (cellphone number and email address) to communicate important information, including but not limited to calendars, newsletters, billing, and any other necessary information for students, parents, or guardians.
I understand that I may “opt out” of these communications by sending an email to admin@graciefourway.co.za confirming my request.
My signature on this document is evidence that I know and understand and have had this document explained to me, that I fully understand the dangers that are inherent in this martial art, and that I voluntarily certify that I will not hold Gracie Jiu-Jitsu Fourways CC, and each of their owners, agents, stockholders, directors, officers, employees and representatives, responsible for any injury, whether as a result of training or not, including, but not limited to, any loss of personal property.
I acknowledge that I have signed this agreement free and willingly, I have read the contents and understand same and have no objection to the signing thereof.
