Personal Liability Waiver

Student's Name*
First Last
Student's Age*
Please enter a number from 2 to 80.
Because the student is under 18 years of age, this form MUST be completed by a PARENT or GUARDIAN of the student.
Parent/Guardian Name
First Last
Your Email Address*
Please read the following statements and check each box to indicate your acceptance I understand that Hassett’s Jiu-Jitsu Club has taken enhanced measures to insure the health and safety of its members and instructors and I agree to the following stipulations:
Item 1*
- I understand that there is an inherent risk to exposure to Covid-19 and other infectious illnesses and any public place where people are present, including Hassett’s Jiu-Jitsu Club and its outlying properties. I understand Covid-19 is an extremely contagious disease and can lead to severe illness and death.
Item 2*
- By entering and training at Hassett’s Jiu-Jitsu Club I assume all risks related to exposure to Covid-19 or any other infectious disease.
Item 3*
- I certify that I am in good health and symptom free of Covid-19.
Item 3 (for child)*
- I certify that my child is in good health and symptom free of Covid-19.
Item 4*
- I certify to the best of my knowledge that I am Covid-19 negative.
Item 4 (for child)*
- I certify to the best of my knowledge that my child is Covid-19 negative.
Item 5*
- I agree to undergo temperature screening before admittance to Hassett’s Jiu-Jitsu Club and agree to comply with any and all enhanced safety requirements put in place to insure the health and safety of all members and instructors at Hassett’s Jiu-Jitsu Club.
Item 5 (for child)*
- I agree to allow my child to undergo temperature screening before admittance to Hassett’s Jiu-Jitsu Club and agree to comply with any and all enhanced safety requirements put in place to insure the health and safety of all members and instructors at Hassett’s Jiu-Jitsu Club.
Item 6*
- I hereby waive any and all liability of Hassett’s Jiu-Jitsu Club, its owners, operators, instructors, and members regarding my personal health and the exposure to Covid-19 or any other infectious disease.
Item 6 (for child)*
- I hereby waive any and all liability of Hassett’s Jiu-Jitsu Club, its owners, operators, instructors, and members regarding my personal health, the health of my child, and the exposure to Covid-19 or any other infectious disease.
Signature*
Please type your full name (first and last) to indicate your acceptance of all terms outlined herein.
Comments
This field is for validation purposes and should be left unchanged.

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Sewell
422 Delsea Dr
Sewell, NJ 08080
Phone: (856) 218-8333

Williamstown
1161 S Black Horse Pike
Williamstown, NJ 08094
Phone: (856) 218-8333

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