(Mixed Martial Arts), Boxing, Wrestling, Muay Thai, any moves involving chokes, holds, kicks, punches, submission, throws, warm-ups, self defense, games & exercise can cause injuries.

Diamondback Jiu-Jitsu instructs students to take all precautions to avoid injuries. The risk of accidents or injury may occur and this may be serious or even mortal. I understand the risks involved in these activities and have consulted with a doctor/ physician before engaging in ANY physical activities.

I understand that along with the possibility of personal injury, injury to property is also possible such as, but not limited to, loss of wages and ability to earn such wages. I also acknowledge that if an injury should occur I have substantial insurance to cover my accident and or injuries. I have full knowledge of the aforementioned dangers, both to my personal and to my property (current and future) and after having the dangers explained to myself and or legal guardian.

Furthermore, Parents or Guardians are responsible for their children and their property inside the academy. Playing, running, etc. are not allowed in the academy. If children play it is at their own risk and risk of the parents or guardians.

I hereby certify and declare that I will release and forever hold free and discharge from any liability top Arm Bar Factory LLC and Diamondback Jiu-Jitsu, & all Affiliates, Instructors, Assistant Instructors, agents, stockholders, directors, officers, employees, independent contractors, and whatsoever which I 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 Diamondback Jiu-Jitsu.

Further, knowing and understanding these risks, I hereby agree to voluntarily assume these risks and 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 be forever binding on my heirs and assigns.

To instill in our students a sense of personal responsibility, they must have a complete Diamondback Jiu-Jitsu Uniform for all classes. Gi, Belt, and protective wear for sparring is the responsibility of Parents and Students. You may buy these items elsewhere if not available at the academy. If students are not fully uniformed, they will not be able to participate in class. Gi rentals are $10.00 if needed. Students must have a clean uniform for class. Please disinfect gear after usage.

Pictures taken at the academy can be used for academy promotion & advertising.

My Signature on this document is evidence that I know and understand the dangers inherent in martial arts and I voluntarily certify that I will not hold Diamondback Jiu-Jitsu responsible for any injury due to a result of training or otherwise.

INSTRUCTIONS:

• * Indicates required fields

• For Cell Phone and Touch Screen, use finder to sign the document.

• For Desktop Computers, use your mouse to sign the document.

• Click the SUBMIT button once you are done.

*Print Name:

*Signature:

*Today's Date:

Date Of Birth:

Phone Number:

Email: