LIBERTY STATION JIU JITSU

Operated by LS Jiu Jitsu LLC

PARTICIPANT WAIVER, RELEASE OF LIABILITY, ASSUMPTION OF RISK & CONSENT AGREEMENT

Participant: {name}
Date of Birth: {dob}
Emergency Contact: {contact_name}
Emergency Contact Phone: {contact_phone}
Relationship: {contact_relation}

1. ACTIVITIES COVERED BY THIS AGREEMENT

This Agreement applies to participation by the participant identified above ("Participant") in activities offered, sponsored, conducted, or supervised by LS Jiu Jitsu LLC, operating under the Liberty Station Jiu Jitsu brand ("LS Jiu Jitsu"), including but not limited to Jiu Jitsu, grappling, wrestling, takedowns, throws, self-defense training, positional training, technique instruction, drilling, live rolling and sparring, open mat training, competition preparation, seminars, special events, physical conditioning, fitness, strength and movement activities, use of training mats and equipment, activities occurring inside or outside the facility as part of an LS Jiu Jitsu program or event, and other martial arts, fitness, recreational, or related activities offered by LS Jiu Jitsu (collectively, the "Activities").

This Agreement applies whether an Activity is conducted by an LS Jiu Jitsu instructor, coach, employee, volunteer, guest instructor, or other person acting on behalf of or with the permission of LS Jiu Jitsu.

2. INFORMED CONSENT AND ASSUMPTION OF RISK

I understand that Jiu Jitsu and related martial arts are physical-contact activities involving physical exertion, grappling, body positioning, resistance, takedowns, throws, submissions, and contact with instructors, training partners, other participants, equipment, mats, flooring, walls, and other portions of the facility.

I understand that participation in the Activities involves inherent and other risks, whether known or unknown, foreseeable or unforeseeable.

I voluntarily choose to participate, or if signing as the parent/legal guardian of a minor Participant, voluntarily authorize the minor to participate, despite these risks and assume the risks associated with participation to the fullest extent permitted by California law.

These risks include, but are not limited to:

• Sprains, strains, bruises, abrasions, cuts, scrapes, mat burns, and other injuries;

• Muscle, tendon, ligament, joint, and soft-tissue injuries;

• Dislocations and fractures;

• Injuries to the head, face, neck, spine, back, shoulders, arms, hands, fingers, hips, legs, knees, ankles, and feet;

• Concussions and other traumatic brain injuries;

• Loss of consciousness;

• Spinal cord injuries;

• Paralysis;

• Permanent disability;

• Serious illness or death;

• Injuries resulting from takedowns, throws, grappling, submissions, positional control, sparring, rolling, or other physical contact;

• Accidental or unintended actions, movements, mistakes, negligence, or loss of control by the Participant, another participant, instructor, coach, employee, volunteer, visitor, or other person;

• Injuries resulting from differences in age, size, strength, experience, skill level, physical ability, or maturity between participants;

• Failure by the Participant or another participant to follow instructions, rules, safety procedures, or proper technique;

• Slips, trips, falls, collisions, or contact with mats, flooring, walls, doors, fixtures, equipment, or other objects;

• Improper use, malfunction, or failure of equipment;

• Conditions of the facility or premises;

• Strenuous physical exertion;

• Fainting, dizziness, dehydration, abnormal blood pressure, cardiac events, or other medical complications;

• Aggravation of a pre-existing injury, illness, or medical condition;

• Exposure to communicable or contagious diseases or infections, including illnesses or skin conditions that may spread through close physical contact or shared training surfaces;

• Delayed or undetected injuries;

• Emotional or psychological distress associated with physical activity or competition;

• Loss, theft, or damage to personal property; and

• Other risks inherent in or associated with martial arts, physical fitness, recreational activities, and use of the facility.

I understand that appropriate instruction, supervision, safety procedures, equipment, and reasonable precautions cannot eliminate every risk of injury.

I acknowledge that I have read and understand the Assumption of Risk provisions above. CLICK THE BOX BELOW AND ENTER YOUR INITIALS:

3. PHYSICAL CONDITION AND MEDICAL RESPONSIBILITY

I understand that LS Jiu Jitsu does not provide medical advice, diagnosis, treatment, or medical clearance.

I am responsible for determining whether I am physically and medically capable of participating or, if signing for a minor Participant, whether the minor Participant is physically and medically capable of participating in the Activities.

I agree to consult a physician or other qualified healthcare professional when appropriate before participation.

I agree to notify LS Jiu Jitsu or an instructor of any relevant physical limitation, injury, illness, medical condition, allergy, or other circumstance that could affect safe participation.

I understand that LS Jiu Jitsu may modify, restrict, pause, suspend, or discontinue participation when an instructor or staff member reasonably believes doing so is necessary for safety.

4. RELEASE AND WAIVER OF LIABILITY

In consideration for being permitted to participate in the Activities, I, on behalf of myself and my personal representatives, heirs, successors, and assigns, hereby release and discharge LS Jiu Jitsu LLC, the operator of Liberty Station Jiu Jitsu, and its owners, officers, managers, instructors, coaches, employees, agents, volunteers, representatives, and persons acting on its behalf (collectively, the "Released Parties") from claims and liabilities arising out of or relating to participation in the Activities or use of the LS Jiu Jitsu facility, including claims based upon the ordinary negligence of the Released Parties, to the fullest extent permitted by California law.

I expressly understand that this release is intended to include claims based upon the ordinary negligence of the Released Parties.

This release does not apply to liability that cannot legally be waived or released under California law, including liability for gross negligence, willful misconduct, or any other liability that California law prohibits the parties from releasing.

I understand that by signing this Agreement, I may be giving up valuable legal rights.

I acknowledge that I have read and understand the Release and Waiver of Liability above, including that it releases claims based upon ordinary negligence to the fullest extent permitted by California law. CLICK THE BOX BELOW AND ENTER YOUR INITIALS:

5. PARTICIPANT RESPONSIBILITY AND SAFETY RULES

I agree that the Participant will follow all reasonable safety rules, academy policies, and instructions provided by LS Jiu Jitsu instructors, coaches, and staff.

The Participant agrees, as applicable to the Participant's age and ability, to:

• Follow instructor directions;

• Train responsibly and respectfully;

• Use appropriate control when training with partners;

• Immediately release a submission when a training partner taps or verbally indicates submission;

• Immediately stop or modify an activity when instructed;

• Refrain from intentionally dangerous, reckless, abusive, or inappropriate behavior;

• Maintain appropriate personal hygiene;

• Refrain from training when cuts, open wounds, skin infections, contagious illnesses, or other conditions could reasonably endanger other participants;

• Notify an instructor when the Participant believes they or another participant may be injured or experiencing a medical issue; and

• Treat instructors, staff, training partners, children, parents, visitors, and other members of the LS Jiu Jitsu community with respect.

LS Jiu Jitsu reserves the right, to the fullest extent permitted by law, to modify, restrict, suspend, or terminate participation when conduct presents a safety concern or violates academy policies.

MOUTHGUARD, PROTECTIVE EQUIPMENT & PERSONAL SAFETY

I understand that Jiu Jitsu involves close physical contact and may involve impacts or accidental contact to the mouth, teeth, jaw, face, head, and other parts of the body.

LS Jiu Jitsu recommends that Participants wear a properly fitted mouthguard during Jiu Jitsu training, particularly during live rolling, sparring, takedown practice, competition preparation, and other activities involving increased physical contact.

I understand that a mouthguard may reduce the risk or severity of certain dental and oral injuries but cannot eliminate the risk of injury. I understand that LS Jiu Jitsu does not represent or guarantee that a mouthguard or any other protective equipment will prevent concussion, head injury, dental injury, or other injury.

For the safety of the Participant and training partners, the Participant agrees to:

• Remove jewelry, watches, hard or sharp hair accessories, and other hard, sharp, or potentially hazardous personal items before training;

• Keep fingernails and toenails reasonably trimmed and smooth;

• Wear appropriate training clothing and equipment that does not contain exposed metal, sharp edges, or other components that could reasonably present a risk to another participant;

• Follow instructor directions regarding the use or removal of protective equipment, braces, supports, or other equipment; and

• Notify an instructor of any equipment, dental appliance, medical device, or other circumstance that may affect safe participation.

LS Jiu Jitsu may restrict the use of rigid or other protective equipment when an instructor or staff member reasonably determines that the equipment could present a safety risk to the Participant or another person.

I acknowledge that I have read and understand the Participant Responsibility and Safety Rules above, including LS Jiu Jitsu's recommendation regarding the use of a properly fitted mouthguard. CLICK THE BOX BELOW AND ENTER YOUR INITIALS:

6. COMMUNICABLE ILLNESS AND HYGIENE

I understand that Jiu Jitsu involves close physical contact and shared training surfaces and that participation may increase the risk of exposure to communicable illnesses and infections.

The Participant agrees not to participate when knowingly experiencing a contagious condition that could reasonably endanger other participants and agrees to follow reasonable hygiene, cleaning, illness, and skin-infection policies established by LS Jiu Jitsu.

I understand that these precautions cannot eliminate all risk of illness or infection.

7. EMERGENCY MEDICAL CARE

If the Participant becomes injured or experiences a medical emergency while participating in an Activity or while on the LS Jiu Jitsu premises, I authorize LS Jiu Jitsu personnel to take reasonable steps to obtain emergency assistance, including contacting emergency medical services when appropriate.

I understand that LS Jiu Jitsu personnel are not medical professionals and that any first aid provided is limited to what a person reasonably believes is appropriate under the circumstances.

I understand that I am responsible for applicable medical expenses, including ambulance, emergency room, physician, hospital, rehabilitation, or other medical expenses, except to the extent otherwise required by law.

8. MINOR PARTICIPANTS — PARENT/LEGAL GUARDIAN CONSENT

This section applies when the Participant is under 18 years of age.

If the Participant is a minor, I represent that I am the Participant's parent or legal guardian and have the legal authority to provide consent for the minor to participate in the Activities and to enter into this Agreement.

I understand that children and adolescents have different levels of physical development, coordination, communication skills, judgment, maturity, and understanding of risk.

I understand that particularly young children, including toddlers and preschool-aged children, may not be capable of fully understanding the nature, risks, or legal significance of this Agreement. As the parent/legal guardian, I am providing the informed consent and authorization for the minor Participant's participation.

I understand that Jiu Jitsu and related Activities involve physical contact, physical exertion, and the risks described throughout this Agreement, and I voluntarily authorize the minor Participant to participate despite those risks.

I agree to discuss the Activities and applicable safety expectations with the minor in a manner appropriate to the child's age, maturity, and ability to understand.

For very young children, I understand that instruction may involve age-appropriate games, movement exercises, physical demonstrations, controlled partner activities, grappling movements, positional activities, and other exercises designed for the child's developmental level.

I understand that even with age-appropriate instruction, supervision, safety procedures, and reasonable precautions, young children may fall, collide with another participant or object, move unpredictably, fail to understand or follow an instruction, or otherwise experience an injury.

I authorize LS Jiu Jitsu instructors and staff to provide age-appropriate instruction and to modify, restrict, pause, or discontinue my child's participation when they reasonably believe doing so is necessary for the child's safety or the safety of others.

I understand that very young children may not be capable of complying with every instruction or safety rule and that their participation will be evaluated according to their age and developmental ability.

To the fullest extent permitted by California law, I agree to the applicable terms of this Agreement on behalf of myself and the minor Participant.

Nothing in this Agreement is intended to waive or release any right, claim, or liability that cannot legally be waived or released under California law.

Parent/Guardian Medical Authorization

If the Participant is a minor, I authorize LS Jiu Jitsu personnel to obtain reasonable emergency medical assistance for my child when I cannot be reached promptly or when, in the reasonable judgment of staff, immediate medical attention is necessary.

I understand that LS Jiu Jitsu is not a medical provider and that its personnel may not be able to diagnose or treat injuries or medical conditions.

I understand that emergency medical personnel and healthcare providers are responsible for medical treatment and that I am responsible for applicable medical expenses, except to the extent otherwise required by law.

9. INDEMNIFICATION

To the fullest extent permitted by California law, I agree to indemnify and hold harmless the Released Parties from claims, damages, losses, liabilities, costs, or expenses arising from my negligent or intentional acts or omissions, or those of the Participant for whom I am legally responsible, during participation in the Activities, including claims brought by another participant or third party because of such conduct.

This provision does not require indemnification for liability that cannot legally be shifted or indemnified under California law.

10. PERSONAL PROPERTY

I understand that LS Jiu Jitsu is not responsible for loss, theft, or damage to personal property brought onto or left at the facility, except to the extent liability cannot legally be waived.

Participants and accompanying persons are responsible for their personal belongings and should not leave valuables unattended.

11. VIDEO SURVEILLANCE AND SECURITY CAMERAS

For the safety and security of participants, parents, children, instructors, employees, visitors, and the facility, LS Jiu Jitsu may operate video surveillance cameras in common areas of the facility.

I understand and acknowledge that:

1. Video surveillance may operate continuously during facility operating hours and/or at other times for legitimate security purposes.

2. Cameras may record activity in common areas, including training areas, entrances, exits, reception areas, hallways, and other areas where there is no reasonable expectation of privacy.

3. LS Jiu Jitsu does not intentionally record audio through its security-camera system.

4. Cameras will not intentionally be placed in bathrooms, changing areas, or other locations where individuals have a reasonable expectation of privacy.

5. Video recordings may be used for legitimate safety, security, operational, incident-investigation, insurance, legal, and law-enforcement purposes.

6. Video recordings may be reviewed by authorized LS Jiu Jitsu personnel and, when reasonably necessary or legally required, may be provided to law enforcement, insurance providers, attorneys, courts, or other authorized persons in connection with an incident, investigation, claim, legal obligation, or safety matter.

7. Video recordings may be stored electronically and may be automatically overwritten or deleted according to LS Jiu Jitsu's applicable retention practices, except when footage is preserved because it may be relevant to an incident, investigation, claim, dispute, insurance matter, legal proceeding, or legal preservation obligation.

8. Video surveillance does not guarantee the prevention of injury, theft, misconduct, or other incidents.

9. I acknowledge that the Participant and accompanying persons may be captured by security cameras while present in monitored common areas of the facility.

Security-camera footage is intended for safety, security, and related legitimate operational purposes and is not intended to constitute consent for LS Jiu Jitsu to use a person's likeness for advertising, marketing, promotional, or social-media purposes.

12. ELECTRONIC SIGNATURE

I understand and agree that an electronic signature, digital acceptance, or other electronic acknowledgment of this Agreement is intended to have the same force and effect as a handwritten signature to the fullest extent permitted by applicable law.

I agree that my electronic signature constitutes my acknowledgment that I have read, understood, and voluntarily agreed to this Agreement.

13. GOVERNING LAW AND VENUE

This Agreement shall be governed by and interpreted under the laws of the State of California.

To the extent permitted by applicable law, any legal action relating to this Agreement or participation in the Activities shall be brought in a court of appropriate jurisdiction in San Diego County, California.

14. SEVERABILITY

If any provision of this Agreement is determined to be invalid, unenforceable, or contrary to law, that provision shall be limited or severed to the minimum extent necessary, and the remaining provisions shall remain in full force and effect to the fullest extent permitted by law.

15. ENTIRE AGREEMENT

This Agreement represents the understanding between the signer, Participant, and LS Jiu Jitsu LLC, operator of Liberty Station Jiu Jitsu ("LS Jiu Jitsu"), concerning assumption of risk, release of liability, and the other matters addressed herein.

I understand that this Agreement applies to participation in LS Jiu Jitsu Activities and remains applicable to participation unless and until superseded by a later agreement.

16. FINAL ACKNOWLEDGMENT

I CONFIRM THAT I HAVE CAREFULLY READ THIS AGREEMENT.

I understand that Jiu Jitsu and related physical activities involve inherent risks, including the possibility of serious injury, permanent disability, illness, paralysis, or death.

I understand the nature of the Activities and the risks described in this Agreement.

If I am the Participant, I voluntarily choose to participate.

If I am signing as the parent or legal guardian of a minor Participant, I voluntarily authorize the minor Participant to participate and confirm that I have authority to provide that consent.

I understand that by signing this Agreement I am giving up or limiting certain legal rights, including certain claims based upon ordinary negligence, to the fullest extent permitted by California law.

I have had the opportunity to ask questions and seek independent legal advice before signing if I chose to do so.

I enter into this Agreement voluntarily and without coercion.

Participant: {name}
Participant Date of Birth: {dob}

Signed By (Adult Participant or Parent/Legal Guardian):

Date Signed: {sign_date}