PARTICIPANT PERSONAL DETAILS

Email

EMERGENCY CONTACT

Relationship

If referral / Other

HEALTH QUESTIONNAIRE

MEDICAL HISTORY

If you have answered 'Yes' to any of the above questions, please provide detailed information about your condition(s), including the nature of the injury, ailment, or condition, duration, any regular medications taken (including type and dosage), and relevant details regarding heart disease or heart conditions. This information will help us ensure a safe and suitable training environment for you.

GUARDIAN’S NAME

(Required for participants under 16)

WAIVER AND RELEASE OF LIABILITY

Please read this section carefully In consideration of being allowed to participate in the Garra Brazilian Jiu-Jitsu Academy Program, any related event and/or activity, the Participant: Agrees and acknowledges that all participants will be engaging in activities that involve risk of serious injury, including permanent disability and death, of which social and economic loss or damage might result not only from the Participant’s own actions, inactions or negligence, but also the actions, inactions or negligence of other participants, including but not limited to unforeseeable risks, the rules of play, the conditions of premises or equipment used. Agrees that they will inspect the premises, all facilities and associated equipment, should the Participant be of the opinion that such is unsafe, they must immediately advise their coach or staff member of the Garra Brazilian Jiu-Jitsu Academy of the conditions and refuse to participate, until a suitable and satisfactory rectification occurs. Assumes all the foregoing risks arising from participating in and associated with Brazilian Jiu-Jitsu and other forms of martial arts as offered by the Garra Brazilian Jiu-Jitsu Academy and accepts all personal responsibility for any such, cost, expense, loss or damage, injury, permanent or otherwise, disability or death. Releases, waives, discharges the Garra Brazilian Jiu-Jitsu Academy, its affiliated clubs, regional sports organisations, their respective administrators, directors, agents, coaches, and other employees of the organisation, other participants, sponsoring agencies, sponsors, advertisers, and, if applicable, owners and leasers of any used premises, from any and all liability to the Participant for any and all claims, costs, expenses, demands, losses or damages on account of injury including death or damage to property, caused or alleged to be caused by negligence. WEBSITE/MEDIA AND SOCIAL NETWORKING I hereby release Garra Group Pty Ltd inclusive of Garra Pty Ltds’ representatives, employees, managers, members, officers, parent companies, subsidiaries, and directors, from all claims and demands arising out of or in connection with any use of said “Materials”, including, without limitation, all claims for invasion of privacy, infringement of my right of publicity, defamation and any other personal and/or property rights. I authorise and agree that Garra Group Pty Ltd may take and use photographs, videos or likenesses of myself or my child as needed for its record keeping, advertising, social media and/or public relations projects and that I have no rights to the same and will not be compensated for the same. The Participant declares that they have read and that they understand the terms of the above Waiver and Release and now signs this Waiver voluntarily.

YOUR RESPONSIBILITY

It is your responsibility to: 1. Detail all current medical conditions/health concerns. 2. Detail all previous medical history and conditions. 3. Advise staff of any changes to ongoing medical conditions. DECLARATION I declare that the information I have given as above is true and correct. I accept that exercise is not without risks and injuries/damage. I hereby certify that I understand the risks and accept them as known associated risks of Brazilian Jiu-Jitsu and hereby certify that I have elected voluntarily to participate in Brazilian Jiu-Jitsu exercise.