In consideration of being permitted to utilize the facilities, services and programs of Five Points Jiu Jitsu including, but not limited to, observations or use of facilities and equipment and participation in any program, I, on behalf of myself, or applicable children, dependents or personal representatives, hereby:
1: Acknowledge that I have (a) read this release and waiver of liability; (b) had the opportunity to inspect the school’s facilities and equipment or will immediately upon entering or participating, inspect and carefully consider such premises, facilities and programs; (c) accept the facilities, equipment and program as being safe and reasonably suited for the purpose intended and (d) voluntarily sign this release and waiver of liability.
2: Release the school, its directors, officers, employees, agents and volunteers (collectively “School Releasees) from all liability to me for any loss of damage to property or injury or death to person, whether caused by the ordinary negligence of the School Releasees or any other person, and while I am in, upon or about any school equipment therein or participating in any program or service affiliated with the school.
3: Agree not to sue the School Releasees for any loss, liability, damage, injury or death described above and I agree to indemnify and hold harmless the School Releasees and each of them from any loss, damage or cost they may include due to my presence in, upon or about the School facilities or equipment therein or from my participating in any program or service affiliated with the School whether caused by the ordinary negligence or the School Releasees or by any other person. I assume full responsibility for the risk of such loss, liability, damage, injury or death.
I intend for this release and waiver of liability to be as broad and inclusive as is permitted by the laws of the state of Illinois. If any portion hereof is held invalid, I agree that the balance shall continue in full force and effect. I hereby state that I am joining Five Points Jiu Jitsu of my own volition and that I have not been pressured to join in any way whatsoever.
Emergency Contact: ____________________
Emergency Contact Phone: ________________________
Signer Name or Guardian Signing Document: __________________________________
Signed On: ____________