XSignature Printed Name Date

XLegal Guardian's Signature Legal Guardian's Printed Name Date

Legal Guardian's Street AddressMember Information (Please Print):The information written on this form will not be shared with any person or entity not associated with Redline Brazilian Jiu-Jitsu.

Last Name: First Name: Birthday:

City: State: Zip:

Phone #: E-Mail:

Emergency Contact Information (Please Print):

Last Name, First Name: Phone #:Member Billing Information (Please Print):The information written on this form will not be shared with any person or entity not associated with Redline Brazilian Jiu-Jitsu.

Name: CC/Debit #:

City: State: Zip:

Street Address:

WAIVER OF LIABILITY: MEMBER ACKNOWLEDGES THAT THE USE OF REDLINE BRAZILIAN JIU-JITSU'S FACILITIES, EQUIPMENT, MERCHANDISE, SERVICES, AND PROGRAMS (INCLUDING PRIVATE LESSONS) INVOLVES AN INHERENT RISK OF PERSONAL INJURY TO MEMBER AND MEMBER'S GUESTS AND INVITEES. MEMBER VOLUNTARILY AGREES TO ASSUME ALL RISKS OF PERSONAL INJURY TO MEMBER, MEMBER'S SPOUSE, CHILDREN, UNBORN CHILDREN, OTHER FAMILY MEMBERS, GUESTS, OR INVITEES AND WAIVES ANY AND ALL CLAIMS OR ACTIONS THAT MEMBER MAY HAVE AGAINST REDLINE BRAZILIAN JIU-JITSU, ANY OF ITS INSTRUCTORS, ANY OF ITS PAST, EXISTING, OR FUTURE STUDENTS, ANY PERSON WHO GIVES RECOMMENDATIONS, DIRECTIONS, OR INSTRUCTIONS, ITS PARENT, AND ANY AFFILIATES AND FOR EACH OF THEM, THEIR DIRECTORS, OFFICERS, AGENTS, MEMBERS, AND EMPLOYEES, AND ASSIGNS FOR ANY SUCH PERSONAL INJURY (AND NO SUCH PERSON OR ENTITY SHALL BE LIABLE TO MEMBER, MEMBER'S SPOUSE, CHILDREN, UNBORN CHILDREN, OTHER FAMILY MEMBERS, GUESTS, OR INVITEES FOR SUCH PERSONAL INJURY), INCLUDING, WITHOUT LIMITATIONS: (I) INJURIES ARISING FROM PARTICIPATION IN SUPERVISED OR UNSUPERVISED ACTIVITIES AND PROGRAMS ON, RELATED TO, OR SPONSORED BY REDLINE BRAZILIAN JIU-JITSU; (II) INJURIES ARISING FROM THE USE OF TECHNIQUES TAUGHT OR SHARED AT REDLINE BRAZILIAN JIU-JITSU, WHETHER ON OR OFF REDLINE BRAZILIAN JIU-JITSU PREMISES; (III) INJURIES ARISING FROM REDLINE BRAZILIAN JIU-JITSU'S NEGLIGENCE, WHETHER DIRECT OR INDIRECT; (IV) INJURIES, DISEASE, INFECTION, OR MEDICAL DISORDERS RESULTING FROM VISITATION AT REDLINE BRAZILIAN JIU-JITSU, INCLUDING, WITHOUT LIMITATIONS, HEART ATTACKS, STROKES, HEAT STRESS, SPRAINS, BROKEN BONES AND TORN OR DAMAGED MUSCLES, LIGAMENTS, OR TENDONS; (V) INJURIES ARISING FROM USE OF ANY EQUIPMENT; (VI) ACCIDENTAL INJURIES ON REDLINE BRAZILIAN JIU-JITSU'S PREMISES. THE PROVISIONS OF THIS PARAGRAPH SHALL SURVIVE THE TERMINIATION OF THIS AGREEMENT AND MEMBER'S MEMBERSHIP.

ASSUMPTION OF RISK AND INDEMNIFICATION: Member acknowledges that Redline Brazilian Jiu-Jitsu does not manufacture any of the equipment at its facilities; accordingly, neither Redline Brazilian Jiu-Jitsu nor its parent, nor any of its affiliates nor any of their respective owners, instructors, or assigns shall be held liable for any such defective equipment or products, or any injures incurred while utilizing equipment or services at Redline Brazilian Jiu-Jitsu or related functions. Member shall indemnify Redline Brazilian Jiu-Jitsu, its parent, any affiliates, and each of their respective owners, instructors, and assigns and save and hold each of them harmless against and pay on behalf of or reimburse any such indemnified party as and when incurred for any losses which such indemnified party may suffer, sustain, or become subject to, as a result of, in connection with, relating or incidental to or by virtue of any claim that is the subject of the waiver set forth above. The provisions of this paragraph shall survive the termination of this Agreement and Member's membership.

I HAVE READ THIS WAIVER OF LIABILITY AND ASSUMPTION OF RISK AND INDEMNITY AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT COERCION, AND WITHOUT ASSURANCE, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY TO THE GREATEST EXTENT ALLOWED BY LAW.

Minor Release - Legal Guardian: Any member who is under the age of 18 must have a parent or legal guardian co-sign this Agreement. Legal Guardian shall be jointly and severally liable for any and all obligations of such Member hereunder and shall be bound by all terms and conditions of this Agreement.

Billing Address:

2 of 2 REV: May 2014