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In consideration of being permitted to: 1) physically participate in any program offered by

Jewel Jiu Jitsu Academy, LLC (hereinafter “Jewel Jiu Jitsu Academy”); and 2) in so

doing, enter any restricted area (defined as any area where admittance to the general

public is prohibited), the Participant [or for minor participants, such minor’s parent(s) or

legal guardian(s)] agree(s) and acknowledge(s) that:

1a. There are risks and dangers associated with participation in martial arts events and

activities that could result in bodily injury, partial and/or total disability, paralysis and/or

death.

b. The social and economic losses and/or damages, which could result from the risks

and dangers described above, could be severe.

c. Such 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 Releasees’ (as defined in paragraph 4 below).

d. There may be other risks not known to the Releasees or which were not reasonably

foreseeable.

2. I/WE have elected to participate in the activities organized and sponsored by the

Releasees and hereby accept and assume all risks and sole responsibility for any

losses and/or damages that I/WE may suffer as the result of injury, disability, paralysis or

death, however caused and whether caused in whole or in part by the negligence of the

Releasees named below. Furthermore, I/WE expressly acknowledge that any injury we

may suffer as a result of such participation may be worsened or further compounded or

increased as the result of rescue efforts or procedures undertaken by any of the

Releasees.

3. I/WE have the responsibility to inspect the facilities and equipment to be used,

and if I/WE believe anything to be unsafe, to immediately advise Releasees of such

condition, avoid the unsafe area and refuse to participate in any activity that I/WE

believe to be unsafe.

4. In exchange for permission to participate in the sponsored activities of

Jewel Jiu Jitsu Academy, I/We HEREBY RELEASE, WAIVE, DISCHARGE AND

COVENANT NOT TO SUE Jewel Jiu Jitsu Academy, LLC, its members, officers,

employees, agents, and instructors; or any individual or entity associated with any other

martial arts school or training facility used by the Participant (including their respective

owner(s), manager(s), promoter(s), lessor(s) and/or lessee(s), employees, or agents of

any premises) to conduct any Jewel Jiu Jitsu Academy martial arts event or program (all

of whom shall be referred to as the “Releasees”) from any and all liability to the

undersigned, my/our personal representatives, assigns, executors, heirs and next of 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 or damage to

property, arising out of or relating to (either in whole or in part) MY/OUR participation in

any class, event or training sponsored or led by the Releasees.

5. I/WE acknowledge and give to Jewel Jiu Jitsu Academy, LLC and the Releasees,

MY/OUR permission and consent to take, use, publish, distribute or copyright any

photographic pictures, videos, or other images of or including, the undersigned

(regardless of medium, form or format) in which I/WE may be included (the “Image”) in

whole or in part or composite, created or made in conjunction with MY/Our participation

in activities organized or sponsored by Jewel Jiu Jitsu Academy, either on websites or in

emails or elsewhere for any lawful purpose. I/WE further agree to waive any and all

rights that I/WE may have to the prior inspection and/or approval of, any Image

(preliminary or final) referred to herein. I/WE further release the Releasees’ (including

any photographer or other person who captured My/Our Image) from any claim for

remuneration associated with MY/OUR Image or its capture. Lastly, I/WE acknowledge

that this release was freely given and executed.

6. I/WE further agree that the foregoing release, waiver, and indemnity agreement is

intended to be as broad and inclusive as is permitted by the law of the Commonwealth

or State in which the event is conducted and that if any portion is held invalid, it is

agreed that all remaining terms of this Release and Waiver of Liability shall continue on

in full legal force and effect.

7. In the event that Participant is a minor, I/WE (as the parent or legal guardian(s) of

a minor Participant) acknowledge and agree that in the event (and despite this

Release), said minor Participant makes an actual claim against any of the Releasees,

that I/WE shall reimburse any Releasee for any and all amounts (including any awards,

settlement, costs or expenses) incurred by Releasees in defending against Participant’s

claim and hold them harmless.

I/WE HAVE READ THIS RELEASE AND WAIVER OF LIABILITY AND FULLY

UNDERSTAND ITS TERMS. I/WE FURTHER UNDERSTAND THAT I/WE WILL GIVE

UP SUBSTANTIAL RIGHTS BY SIGNING IT. IN ADDITION, I/WE CAN STATE THAT

I/WE HAVE SIGNED THIS AGREEMENT FREELY AND VOLUNTARILY WTHOUT

ANY INDUCEMENT, ASSURANCE, OR GUARANTEE BEING MADE TO ME/US AND

INTEND MY/OUR SIGNATURE TO BE COMPLETE AND UNCONDITIONAL

RELEASE OF ALL LIABILITY TO THE MAXIMUM EXTENT ALLOWED BY LAW.