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• I, THE ABOVE NAMED PARTICIPANT, BY SIGNING THIS DOCUMENT HEREBY DECLARE THAT I FULLY REALIZE AND CLEARLY UNDERSTAND THE INHERENT DANGERS INVOLVED IN ENGAGING IN THE PRACTICE OF SELF-DEFENSE, MARTIAL ARTS, JU-JITSU AND/OR RELATED ACTIVITIES. I FULLY REALIZE AND CLEARLY UNDERSTAND THAT I AM PLACING MYSELF IN DANGER OF POSSIBLE BODILY INJURY. IT IS WITH FULL REALIZATION AND CLEAR UNDERSTANDING OF THE AFOREMENTIONED DANGERS THAT I AGREE TO BECOME A PARTICIPANT IN THIS ACTIVITY AND HEREBY AGREE TO THE FOLLOWING TERMS AS A CONDITION FOR PARTICIPATION IN THESE CLASSES:
• THAT DURING AND AT ALL TIMES THAT I AM A PARTICIPANT IN THIS ACTIVITY AND ANY RELATED ACTIVITY, SUCH AS TOURNAMENTS, WORKSHOPS, AND DEMONSTRATIONS, I SHALL BE LIABLE FOR ANY AND ALL INJURIES I SUSTAIN OR INCUR DURING AND RELATED TO THE COURSE OF INSTRUCTION, EXERCISES, PRACTICE, AND RELATED ACTIVITIES AND WILL NOT HOLD THE SPONSOR[S], ITS GOVERNING BODY[IES], OFFICIALS, EMPLOYEES AND MEMBERS, EITHER INDIVIDUALLY OR OTHERWISE, LIABLE FOR ANY SUCH INJURIES OR ANY LOSS OR DAMAGES ARISING THEREFROM. I ALSO REALIZE THAT I AM RESPONSIBLE FOR PROVIDING MY OWN MEDICAL INSURANCE OR MEDICAL COVERAGE TO COVER ANY AND ALL MEDICAL EXPENSES I MIGHT INCUR IN PARTICIPATING IN THIS ACTIVITY. I FURTHER REALIZE THAT EVEN WITH A COMBINATION OF INSURANCE POLICIES THERE MAY BE ADDITIONAL MEDICAL EXPENSES NOT COVERED BY INSURANCE, AND I MUST ASSUME ANY AND ALL FINANCIAL RESPONSIBILITY BEYOND WHAT ANY INSURANCE POLICY/IES MAY PROVIDE.
•  THAT I, INTENDING TO BE LEGALLY BOUND, HEREBY FOR MYSELF, MY HEIRS, EXECUTORS, AND ADMINISTRATORS, RELEASE, DISCHARGE WAIVE AND RELINQUISH ANY AND ALL RIGHT TO DAMAGES, CLAIMS OR ACTIONS I HAVE AGAINST THE SPONSOR[S], ITS GOVERNING BODY[IES], OFFICIALS, EMPLOYEES AND MEMBERS, EITHER INDIVIDUALLY OR OTHERWISE, FOR INJURIES OR RIGHTS TO LOSSES OR DAMAGES SUFFERED BY ME, DIRECTLY OR INDIRECTLY, INCLUDING ANY FUTURE PSYCHOLOGICAL AND/OR PHYSICAL INJURY, PAIN AND SUFFERING, PROPERTY DAMAGE ANd/OR WRONGFUL DEATH CLAIMS, INCLUDING BUT NOT LIMITED TO ATTENDING, PARTICIPATING IN, PRACTICING FOR, TRAVELING TO OR FROM SUCH ACTIVITY OR ANY RELATED ACTIVITIES, OR THOSE CLAIMS OR ACTIONS ARISING OUT OF ANY NEGLIGENCE ON THE PART OF FUSION SELF DEFENSE [AKA FULL CIRCLE JUJITSU, LLC] THE OWNERS, ORGANIZATIONS, GOVERNING BODY[IES], EMPLOYEES, MEMBERS OR INSTRUCTOR(S), EITHER INDIVIDUALLY OR OTHERWISE, OF THE GYMNASIUM, DOJO, SCHOOL, OR PLACE WHERE THESE OR RELATED ACTIVITIES ARE HELD.
• THAT I ALSO AGREE TO DEFEND, INDEMNIFY, AND HOLD THE SPONSOR[S], ITS GOVERNING BODY[IES] OR EMPLOYEES, OR THE INSTRUCTORS OF THE PROGRAM, EITHER INDIVIDUALLY OR OTHERWISE, HARMLESS FROM ANY CLAIMS AND ACTION BY THIRD PARTIES ALLEGING INJURY FROM MY USE OF THE TECHNIQUES AND SKILLS LEARNED DURING AND RELATED TO THE COURSE OF INSTRUCTION, EXERCISES, PRACTICE, AND RELATED ACTIVITIES.
• THAT I HAVE CONSULTED WITH MY A PHYSICIAN AND THAT I AM IN PROPER HEALTH AND PHYSICAL CONDITION TO PARTICIPATE IN THE ACTIVITIES STATED ABOVE. I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, I HAVE NO PRE-EXISTING PHYSICAL CONDITION THAT MAY RESULT IN A DANGER TO MYSELF, OR OTHERS, THROUGH THE PARTICIPATION IN A PHYSICALLY INTENSE PROGRAM, OR PHYSICAL CONTACT WITH OTHERS.
• THAT I HEREBY AUTHORIZE ANY PHYSICIAN, MEDICAL PRACTITIONER, HOSPITAL, CLINIC OR OTHER MEDICAL OR MEDICALLY RELATED FACILITY, OR ANY OTHER INSURANCE COMPANY TO DISCLOSE OR RELEASE ANY INFORMATION IN ITS POSSESSION ABOUT THE MEDICAL HISTORY, MENTAL OR PHYSICAL CONDITION OR TREATMENTS OF THE ABOVE NAMED PARTICIPANT AND/OR THE ABOVE NAMED PARTICIPANT'S FAMILY TO THE AMERICAN JU-JITSU ASSOCIATION, THE SPONSORING AGENCY, ITS AUTHORIZED EMPLOYEES OR REPRESENTATIVES, OR ITS AGENTS.
• THAT I FURTHER AGREE TO FOLLOW ALL RULES AND INSTRUCTIONS, BOTH WRITTEN AND VERBAL, AS STATED IN THE STUDENT HANDBOOK AND/OR BY THE OFFICIALS AND/OR AUTHORIZED INSTRUCTORS.
• THAT I WAIVE ANY AND ALL RIGHTS TO COMPENSATION, IN ANY FORM, FOR PICTURES, FILMS, OR VIDEOTAPES TAKEN OF ME IN THE ABOVE ACTIVITY AND GRANT PERMISSION FOR THEM TO BE USED FOR ANY PUBLICITY OR PUBLICATION PURPOSES.
• THAT IF ANY PROVISION IS FOUND TO BE UNENFORCEABLE OR INVALID, THAT PORTION SHALL BE SEVERED FROM THIS CONTRACT. THE REMAINDER OF THE CONTRACT WILL THEN BE CONSTRUED AS THOUGH THE UNENFORCEABLE PROVISION HAD NEVER BEEN CONTAINED IN THIS CONTRACT.
• I, FURTHER AGREE THAT THE EXECUTION OF THIS AGREEMENT IS CONSIDERATION, IN PART, FOR BEING ABLE TO PARTICIPATE IN THIS ACTIVITY AND I UNDERSTAND THAT MY FAILURE TO EXECUTE THIS AGREEMENT IN FULL WOULD RESULT IN MY NOT BEING ABLE TO PARTICIPATE IN THE ABOVE STATED ACTIVITY, EXERCISES, PRACTICE, AND RELATED ACTIVITIES CONDUCTED BY THE OFFICIALS AND/OR INSTRUCTORS OF THIS PROGRAM THROUGH THE SPONSORING AGENCY. I ALSO UNDERSTAND THAT I HAVE THE RIGHT TO RECEIVE A COPY OF THIS PARTICIPANT AGREEMENT UPON MY REQUEST.
• THIS AGREEMENT IS TO REMAIN IN EFFECT UNTIL REVOKED IN WRITING AND SUCH WRITTEN REVOCATION IS DELIVERED TO THE SPONSORING AGENCY, OR ITS AUTHORIZED REPRESENTATIVE.

I, , THE UNDERSIGNED PARENT OR LEGAL GUARDIAN OF THE ABOVE NAMED MINOR, {name}, DO HEREBY AUTHORIZE THE AMERICAN JUJITSU ASSOCIATION, THE SPONSORING AGENCY, THEIR OFFICIALS, OR THEIR DESIGNATED REPRESENTATIVE AS AGENT FOR THE UNDERSIGNED TO CONSENT TO ANY X-RAY EXAMINATION, ANESTHETIC, MEDICAL OR SURGICAL DIAGNOSIS OR TREATMENT AND HOSPITAL CARE WHICH IS DEEMED ADVISABLE BY, AND IS RENDERED UNDER THE GENERAL OR SPECIAL SUPERVISION OF ANY PHYSICIAN AND SURGEON LICENSED UNDER THE PROVISIONS OF THE MEDICINE PRACTICE ACT ON THE MEDICAL STAFF OF A LICENSED HOSPITAL, WHETHER SUCH DIAGNOSIS OR TREATMENT IS RENDERED AT THE OFFICE OF SAID PHYSICIAN OR AT SAID HOSPITAL.

IT IS UNDERSTOOD THAT THIS AUTHORIZATION IS GIVEN IN ADVANCE OF ANY SPECIFIC DIAGNOSIS, TREATMENT, OR HOSPITAL CARE REQUIRED, BUT IS GIVEN TO PROVIDE AUTHORITY AND POWER ON THE PART OF THE AFORESAID AGENT TO GIVE SPECIFIC CONSENT TO ANY AND ALL SUCH DIAGNOSIS, TREATMENT OR HOSPITAL CARE WHICH THE AFOREMENTIONED PHYSICIAN IN THE EXERCISE OF THEIR BEST JUDGEMENT MAY DEEM ADVISABLE.

I,, REALIZE THAT EVEN WITH A COMBINATION OF INSURANCE POLICIES THERE MAY BE ADDITIONAL MEDICAL EXPENSES NOT COVERED BY INSURANCE AND AS THE PARTICIPANT’S PARENT OR GUARDIAN, I MUST ASSUME ANY AND ALL FINANCIAL RESPONSIBILITY BEYOND WHAT ANY INSURANCE POLICIES MAY PROVIDE.  I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE, THE MEDICAL EMERGENCY INFORMATION FOR THE PARTICIPANT IS TRUE AND COMPLETE.

THIS AUTHORIZATION IS GIVEN PURSUANT TO PROVISIONS FROM THE FAMILY CODE OF THE STATE OF ARIZONA. THIS AUTHORIZATION SHALL REMAIN EFFECTIVE UNTIL REVOKED IN WRITING AND SUCH WRITTEN REVOCATION IS DELIVERED TO FUSION SELF-DEFENSE, SAID AGENT, THE SPONSORING AGENCY, &/OR ITS AUTHORIZED REPRESENTATIVE.

Assumption of the Risk and Waiver of Liability Relating to the Novel Coronavirus / Pandemic / COVID-19

The Novel Coronavirus, COVID-19, has been declared an ongoing worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. When applicable, we will comply with the federal, state & local governments, as well as the state & federal health agencies recommended guidelines on social distancing and the congregation of groups of people. FUSION SELF-DEFENSE [AKA Full Circle Jujitsu, LLC] has put preventative measures in place and worked with the facilities in which it operates in, to reduce the spread of COVID-19; however, FUSION SELF-DEFENSE can't guarantee that you, your child(ren), and/or guests will not become infected with COVID-19. Furthermore, attending sessions with FUSION SELF-DEFENSE could increase the risk of exposure to COVID-19 to you, your child(ren), &/or guests. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that my child(ren), guests, & I may be exposed to or infected by COVID-19 by attending sessions conducted by FUSION SELF-DEFENSE and that such exposure or infection may result in personal injury, illness, permanent disability, &/or death. I understand the risk of becoming exposed to &/or infected by COVID-19 at a FUSION SELF-DEFENSE event. Further, it may result from the actions, omissions, &/or the negligence of myself and others, including, but not limited to, FUSION SELF-DEFENSE owners, officers, employees, sub-contractors, agents, volunteers, facility management & staff, program participants & their families. I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my child(ren) or myself (including, but not limited to, personal injury, disability, &/or death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my child(ren)’s attendance in a FUSION SELF-DEFENSE event or any participation in FUSION SELF-DEFENSE programming (“claims”). On my behalf, and on the behalf of my child(ren), I hear by release, covenant not to sue, discharge, and hold harmless FUSION SELF-DEFENSE [AKA Full Circle Jujitsu LLC], its owners, officers, employees, sub-contractors, agents, representatives, volunteers, facility management & staff of and from the claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any claims based on the actions, omissions, or negligence of FUSION SELF-DEFENSE, its owners, officers, employees, sub-contractors, agents, representatives, volunteers, facility management & staff, whether a COVID-19 infections occurs before, during, or after participation in any FUSION SELF-DEFENSE MARTIAL ARTS PROGRAM. 

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