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Point Break Brazilian Jiu Jitsu – Waiver Form 

Name: {name} Date of Birth: {dob} 

Address: {address} 

Phone: {phone}

Point Break Brazilian Jiu Jitsu academy Waiver release and assumption of risk. Please read carefully. This document affects your legal rights. 

I {name} do hereby submit my application for participation in the instruction of Jiu Jitsu taught at Point Break Brazilian Jiu Jitsu academy.

I hereby assume full responsibility and liability for all damages, injuries and losses that I may incur while participating in or watching any and all training sessions. I realise that serious injury in martial arts such as this one is quite likely and that even death is a very real possibility.

I also realize that if I am injured, I might be disfigured, disabled and or rendered unable to work again. I realise that regardless of how these consequences may occur – whether it be the result of an opponent’s actions, the action or inaction of a training partner or instructor , the condition of the mats used, the conduct of a non-participant or any other reason – By entering into this agreement I accept the risk of training and being present at the Academy and give up and waive all claims I or anyone acting on my behalf or through me might have against the Australian Federation of Brazilian Jiu Jitsu Inc, Point Break Brazilian Jiu Jitsu, Professor Rhys Dykes , any and all of the instructors at the Point Break Brazilian Jiu Jitsu, training partners, operators, sponsors, officials, participants, non-participants or any employees and representatives for any injury regardless of its nature, effect or affect on me as a result of my participation and or presence at the Point Break Brazilian Jiu Jitsu academy. I authorise whatever medical personnel that may be present at the Academy to take any action necessary, should I become injured. I represent that I am in good health; that I am not presently, nor will I participate while under the influence of any drug medication; that no one affiliated with this Academy has adversely encouraged me to train or made any representations regarding my fitness or ability to participate; that I have read and understood every provision of this release; and that I am legally competent to and freely enter into this waiver, release and assumption of risk agreement.        

I {name} acknowledge that I have read and understood the above policies and procedures in its entirety and agree to abide by them.