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LIONS CLASS AGES 9-12 

FOR ANY QUESTIONS MESSAGE STEVEN ERTLE (918) 931-4478

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AGREEMENT

ACCIDENT WAIVER AND RELEASE OF LIABILITY FORM


By signing this waiver, I agree to the above terms and conditions and release Revival Jiu Jitsu and

it's staff from any liability.

I HEREBY ASSUME ALL OF THE RISKS OF PARTICIPATING IN ANY/ALL ACTIVITIES ASSOCIATED WITH THIS

EVENT, including by way of example and not limitation, any risks that may arise from negligence or

carelessness on the part of the persons or entities being released, from dangerous or defective equipment or

property owned, maintained, or controlled by them, or because of their possible liability without fault. I

certify that I am physically fit, have sufficiently prepared or trained for participation in this activity, and have


not been advised to not participate by a qualified medical professional. I certify that there are no health-

related reasons or problems which preclude my participation in this activity. I acknowledge that this Accident


Waiver and Release of Liability Form will be used by the event holders, sponsors, and organizers of the

activity in which I may participate, and that it will govern my actions and responsibilities at said activity. In

consideration of my application and permitting me to participate in this activity, I hereby take action for

myself, my executors, administrators, heirs, next of kin, successors, and assigns as follows: (A) I WAIVE,

RELEASE, AND DISCHARGE from any and all liability, including but not limited to, liability arising from the

negligence or fault of the entities or persons released, for my death, disability, personal injury, property

damage, property theft, or actions of any kind which may hereafter occur to me including my traveling to and

from this activity, THE FOLLOWING ENTITIES OR PERSONS: Revival Jiu Jitsu, Steven Ertle (owner, Revival Jiu

Jitsu) Revival Jiu Jitsu training staff; (B) INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the

entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of

participation in this activity, whether caused by the negligence of release or otherwise. I acknowledge that

Revival Jiu Jitsu and their directors, officers, volunteers, representatives, and agents are NOT responsible for

the errors, omissions, acts, or failures to act of any party or entity conducting a specific activity on their

behalf. I acknowledge that this activity may involve a test of a person's physical and mental limits and carries

with it the potential for death, serious injury, and property loss. The risks include, but are not limited to, those

caused by terrain, facilities, temperature, weather, condition of participants, equipment, vehicular traffic, lack

of hydration, and actions of other people including, but not limited to, participants, volunteers, monitors,

and/or producers of the activity. I hereby consent to receive medical treatment which may be deemed


advisable in the event of injury, accident, and/or illness during this activity. I understand while participating

in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any

legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns. The Accident Waiver

and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum

extent permissible under applicable law.

 I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY

UNDERSTAND ITS CONTENT. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I

SIGN IT OF MY OWN FREE WILL. I AM 18 OR OLDER.

SIGN HERE