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Health & Safety Waiver

Before your first training session at Olivera BJJ, please complete the health and safety waiver, which ensures acknowledgment of any potential risks associated with martial arts training. 

*This form must be signed to participate in classes.

WAIVER

PARTICIPANT ACKNOWLEDGMENT ALL ASSUMPTION OF RISK AND FULLY RELEASE FROM LIABILITY Olivera Jiu Jitsu and Fitness Academy LLC.


PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO: HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES, AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER BUYER'S PARTICIPATION IN THE PHYSICAL ACTIVITIES. PARTICIPANT FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BUYER, SLIP AND FALL BY PARTICIPANT, OR AN UNKNOWN HEALTH PROBLEM OF PARTICIPANT. PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES. PARTICIPANT AFFIRMS THAT PARTICIPANT IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES. PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND PARTICIPANT AGREES THAT IT IS THE RESPONSIBILITY OF PARTICIPANT TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN Olivera Jiu Jitsu and Fitness Academy LLC. PHYSICAL ACTIVITIES.


BY SIGNING THIS AGREEMENT PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES.

PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.

     Participation is Voluntary: The participant has been advised by Olivera martial arts, LLC dba (hereinafter Olivera Jiu Jitsu and Fitness Academy LLC.) that participation in any and all activities is voluntary. Participant understands and agrees that, if at any time, participant feels anything to be unsafe, including but not limited to equipment, facilities and/or activities, participant will immediately take all precautions to avoid the unsafe area, equipment, and/or activity and refuse to participate further.

   Understand risks of participation: Participant fully understands and acknowledges that (a) There are risks and dangers associated with participation in martial arts events and activities which could result in bodily injury partial and/or total disability, contraction of illness and/or disease, paralysis and death, (b) the social, physical, mental, and economic losses and/or damages, which could result from these risks and dangers described above, could be severe, (c) these risks and dangers may be caused by the action, inaction or negligence of the participant or the action, inaction or negligence of others, including, but not limited to, the parties named below, (d) there may be other risks not known to us or are not reasonably foreseeable at this time.

   Acknowledge Risks of participation: Participant hereby acknowledges that the activities are very dangerous and involve the risk of serious injury and/or death and/or property damage. Each of the undersigned also expressly acknowledges that injuries received may be compounded or increased by negligent rescue operations or procedures.

   Acceptance of responsibility/assumption of risk of participation: Participant accepts and assumes such risks and responsibility for the losses and/or damages following such injury, contracted illness or disease, disability, paralysis or death, however caused and whether caused in whole or in part by the negligence of Olivera Jiu Jitsu and Fitness Academy LLC its owners, agents or employees, or by intentional conduct of parties not an owner, agent, instructor, or employee of Olivera Jiu Jitsu and Fitness Academy LLC.   

   Participant Responsibilities: I certify that I am in good health and physical condition, do not have any communicable illnesses, conditions or diseases. I certify that I will not participate in any activities if I am not in good health and physical condition. It is my responsibility to be aware of the demands of the activity at all times. It is my responsibility to be adequately equipped and physically prepared. It is my responsibility to follow the instructions of the designated class leader. Skills taught in this program will not assure my safety in situations of self-defense. I am solely responsible for my own personal safety and the safety of others in the program.

   Minor Participation requirements: In consideration of being permitted to participate in any way with Olivera Jiu Jitsu and Fitness Academy LLC and/or being permitted to enter for any purpose any restricted area (here in defined as any area where in admittance to the general public is prohibited), the parent(s) and/or legal guardian(s) of the minor participant named below agree: Prior to participating in the below martial arts activity or event, the Participant, parent(s) and/or legal guardian(s) will inspect the facilities and equipment to be used, and if he or she believes anything is unsafe, the participant will immediately advise the officials of such condition and refuse to participate.

   Release of liability/covenant not to sue: Participant hereby releases, waives, discharges, and covenant not to sue Olivera Jiu Jitsu and Fitness Academy LLC, the martial arts facility used by the participant, including its owners, managers, promoters, lessees of premises used to conduct the martial arts event or program, premises and event inspectors, underwriters, consultants and others who give recommendations, directions or instructions to engage in risk evaluation or loss control activities regarding the martial arts facility or events held at such facility and each of them, their directors, officers, agents, employees, from all liability to the undersigned, my/our personal representatives, assigns, executors, heirs and next to kin For any and all claims, demands, losses or damages and any claims or demands therefore on account of any injury, including but not limited to the death of the participant or damage to property, arising out of or relating to the events(s) caused alleged to be caused in whole or in part by the negligence of the releasee or otherwise. 

   Release applies to all parties associated with

Olivera Martial Arts LLC: This release applies to all parties including Olivera Martial Arts LLC dba

Olivera Jiu Jitsu and Fitness Academy LLC, Zachary Olivera Sr and/or Krissy Olivera individually and their martial arts community, affiliated individuals, organizations, entities, designated instructors, guest instructors, owners and officers of these organizations, instructors, coaches, assistants, and the owners of the property location.

   Release construed broadly: Each of the undersigned further expressly agrees that the foregoing release, waiver, and indemnity agreement is intended to be as broad and inclusive as is permitted by the law of the Province or State in which the event is conducted and that if any portion is held invalid, it is agreed that the balance shall, notwithstanding continue in full legal force and effect. This release also applies to any dependents, parents, heirs, guardian, family or any other party having the right to pursue any and all claims on my behalf. Participant or Parent/Guardian Signature

    Parent must defend, indemnify, and hold harmless Olivera Jiu Jitsu and Fitness Academy LLC for minor: On behalf of the participant and individually, the undersigned partners(s) and/or legal guardian(s) for the minor participant executes this Waiver and Release. If, despite the release, the participant makes a claim against any of the Releasees, the parents(s) and/or legal guardian(s) will reimburse the Releasee for any money which they have paid to the participant, or on his behalf, and hold them

harmless.

    Release applies to family, heirs etc: This release applies to any claim 1 or any parent, guardian, family member, dependent, heir or any other party having the right to make a claim on behalf against Olivera Jiu Jitsu and Fitness Academy LLC, guest instructors and organizations, the owners of these organizations, the instructors, and any owners of the property location.     

   Only sanctioned use of skills: I understand that the skills taught at Olivera Jiu Jitsu and Fitness Academy LLC, are to be used solely in accord with the law, that I have been explicitly instructed to not use the skills taught at Olivera Jiu Jitsu and Fitness Academy LLC, outside of class with the exception of sanctioned tournaments or MMA events. I am solely responsible for my actions using the skills taught by Olivera Jiu Jitsu and Fitness Academy LLC, and agree to defend and indemnify Olivera Jiu Jitsu and Fitness Academy LLC, for any of my actions that result in claims against Olivera JiuJitsu and Fitness Academy LLC

    Model Release: I agree that Olivera JiuJitsu and Fitness Academy LLC, may use my image, photo, likeness for any purpose, including but not limited to: Olivera JiuJitsu and Fitness Academy LLC, website, promotions, instructional videos, and school advertisements.

    Release of personal property loss: I am responsible for my owner personal property and agree to release and hold harmless Olivera JiuJitsu and Fitness Academy LLC, for any losses of personal property.

    Olivera JiuJitsu and Fitness Academy LLC, Right to prohibit practice or participation: Olivera JiuJitsu and Fitness Academy LLC, reserved the right to prohibit participation for any reason without providing a refund. Validity of release: If any portion of this agreement shall be held invalid, illegal or unenforceable to any extent and for any reason by any Court of competent jurisdiction the remainder of this agreement shall not be affected thereby and shall be enforceable to the full extent permitted by law.

     Participant Medical coverage: By signing below, participant acknowledges that they carry personal medical insurance and/or participant understands that they are solely responsible for their own medical bills and any injury regardless of the cause.

      Attendance and Tuition understanding:Payee understands that regardless of attendance tuition is still owed every month student is enrolled. By signing this agreement you also understand anytime after the initial 90 days from sign up date you may cancel with a 30 day written notice.

I HAVE READ THIS RELEASE AND WAIVER OF LIABILITY ALONG WITH THE COVID-19 POLICIES AND PROCEDURES, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT, AND HAVE SIGNED IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW. I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF FLORIDA THAT THIS STATEMENT IS TRUE AND CORRECT.PARTICIPANT ACKNOWLEDGMENT ALL ASSUMPTION OF RISK AND FULLY RELEASE FROM LIABILITY OLIVERA JIUJITSU AND FITNESS ACADEMY LLC PARTICIPANT ACKNOWLEDGES THESE PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER DAMAGES, INCLUDING, BUT NOT LIMITED TO: HEART ATTACKS, MUSCLE STRAINS, PULLS OR TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT INJURIES, AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING DURING OR AFTER BUYER'S PARTICIPATION IN THE PHYSICAL ACTIVITIES.

PARTICIPANT FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR IMPROPERLY USED EQUIPMENT, OVER-EXERTION OF A BUYER, SLIP AND FALL BY PARTICIPANT, OR AN UNKNOWN HEALTH PROBLEM OF PARTICIPANT.

PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY INVOLVED WITH PARTICIPATION IN THE PHYSICAL ACTIVITIES.

PARTICIPANT AFFIRMS THAT PARTICIPANT IS IN GOOD PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES.

PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY CHALLENGING, AND PARTICIPANT AGREES THAT IT IS THE RESPONSIBILITY OF PARTICIPANT TO SEEK COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN OLIVERA JIUJITSU AND FITNESS ACADEMY LLC, PHYSICAL ACTIVITIES.

BY SIGNING THIS AGREEMENT PARTICIPANT ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES.

PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER PHYSICAL LIMITS.

Please fill out the following form.

Participant Date of birth
Month
Day
Year
Has participant been hospitalized in the last 12 months?
No
Yes
Is participant suffering from a medical condition, illness or injury?
No
Yes
Donations to Olivera's students in need scholarship. thank you for any amount donated.
$5
$25
$185

By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.

I hereby acknowledge with my signature that I am over 18 or I am the legal guardian responsible for the participant.
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