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ASSUMPTION OF RISK AND WAIVER OF LIABILITY 

I {name} represent that I have no physical or mental impairments and that the activities offered by Poway Jiu Jitsu, including but not limited to sparring (defined as any drill, exercise, competition, training session, private or individual class, in which one or more persons makes contact with another by the feet, hands or other parts of the body, whether wearing protective gear or not) inherently involve risk of contact, injury, financial loss or death. I knowingly and voluntarily assume the sole risk, liability, and responsibility for any injury, financial loss or death resulting from my participation in the activity, use of the facility, instruction, or equipment, even when due to active or passive negligence by the club, principals, officers, employees, agents, trainers, or its guests. As additional consideration for my participation in the activity, I and on behalf of my executors, administrators, heirs, does hereby forever release and discharge Poway Jiu Jitsu facility and its owners, operators, instructors, and participants from any and all claims, demands, injuries, actions or causes of action, costs, loss of services, expenses and compensation whatsoever, whether known or unknown, foreseen or unforeseen, anticipated or unanticipated, that I may have, and sign this agreement under my own free will and volition, with full and complete understanding of the nature of the waiver I execute.

I hereby waive any right to inspect or approve the finished photographs or electronic matter that may be used in conjunction with them now or in the future, whether that use is known to me or unknown, and I waive any right to royalties or other compensation arising from or related to the use of the image.

{name}

{dob}

{address}

{phone}

{contact name}

{contact phone}

{sign date}