I acknowledge that participating in Jiu Jitsu and other grappling arts involves inherent risks of physical injury. I understand that these risks include, but are not limited to, bruises, sprains, strains, fractures, concussions, and other potential injuries.
In consideration of being allowed to participate in the activities and programs of the Appalachian Grapplers Association (hereinafter "the Association") and to use the facilities and equipment of Northern Wellness and Fitness Center, I hereby waive, release, and forever discharge the Association, Northern Wellness and Fitness Center, Northern Regional Hospital, their employees and staff, officers, representatives, and agents from any and all responsibilities or liability for injuries or damages resulting from my participation in any activities or my use of equipment or facilities. Furthermore, I agree to hold harmless Northern Wellness and Fitness Center, Northern Regional Hospital, their employees and staff, officers, representatives, and agents from liability for any and all claims, demands, damages, rights or causes of action, present or future, resulting from or arising out of my use of said facilities and equipment.
I agree to inspect the facilities and equipment to be used, and if I believe anything is unsafe, I will immediately advise my coach or supervisor of such condition(s) and refuse to participate. I voluntarily assume all risks associated with my participation in the the Association's activities.
I understand that my participation in the the Association's activities is voluntary, and I have the right to withdraw at any time.
I acknowledge that I have read, understood, and agreed to abide by all the policies, including the Code of Conduct, of the the Association.
In the event of an injury, I authorize the the Association to seek medical treatment on my behalf if I am not able to do so for myself. I agree to be financially responsible for any medical attention needed during training or resulting from an injury received at the the Association.
I affirm that I am in good physical condition and do not have any known medical conditions that would prohibit me from participating in Jiu Jitsu or other forms of grappling.
I acknowledge that the the Association is not equipped to administer medical care beyond basic first aid, such as the application of bandages. In the event of a serious injury, I consent to the Association calling an ambulance to provide necessary medical attention.
I hereby grant the the Association the irrevocable right and permission to capture, use, and publish photographs, videos, or other media containing my image or likeness (hereinafter "the Media") for the purpose of promoting the Association. This includes, but is not limited to, the use of the Media on social media platforms, websites, advertisements, and promotional materials. I acknowledge that the Association owns the copyright to the Media and has the right to edit, alter, copy, exhibit, publish, or distribute the Media for the aforementioned purposes. I waive any right to inspect or approve the finished product wherein my image or likeness appears.
This waiver shall remain in effect for the duration of my membership or involvement with the the Association, unless expressly revoked in writing.
If any portion of this waiver is found to be invalid or unenforceable, the remaining provisions shall continue to be valid and enforceable to the fullest extent permitted by law.
I have read this waiver and release and fully understand its terms. I acknowledge that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily, and intend by my signature to be a complete and unconditional release of all liability to the greatest extent allowed by law.
Participant's Name: ___________________________________________
Participant's Signature: _____________________________________
Date: __________________
If the participant is under the age of 18:
Parent/Guardian Name: ________________________________________
Parent/Guardian Signature: __________________________________
Date: __________________