I hereby agree and acknowledge:

a) I have been advised that the martial art know as "Gracie Jiu-Jitsu" is taught using precautions

to avoid injuries. However, participation in the Gracie Jiu-Jitsu classes carries with it certain

inherent risks and dangers that cannot be eliminated regardless of the care taken to avoid

injuries. The specific risks range from minor injuries such as scratches, bruises, and sprains, to

major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and

concussions, to catastrophic injuries including paralysis and death.

b) The practice of Gracie Jiu-Jitsu presents a risk of skin infections, MRSA, transmittable

diseases, bacteria(s) and viruses, including, but not limited to, COVID-19.

c) I shall not attend Gracie Jiu-Jitsu classes if I am diagnosed with COVID-19 or it I am in close

contact with someone diagnosed with COVID-19. Further, if I am displaying symptoms of COVID-

19, or if I am in close contact with someone who is displaying symptoms of COVID-19, I shall not

attend Gracie Jiu-Jitsu classes. Symptoms of COVID-19 can range from mild illness to

pneumonia, including fever, respiratory symptoms such as coughing, sore throat and/or

shortness of breath, and other symptoms such as runny nose, headache, muscle or joint pains,

nausea, diarrhea, vomiting, loss of sense of smell, altered sense of taste, loss of appetite and

fatigue. If I am displaying these symptoms when in attendance at Gracie Jiu-Jitsu classes I

acknowledge that I may be asked to leave.

d) Along with the possibility of personal injury, injury to property is also possible, including but

not limited to, possible loss of wages and the ability to earn such wages.

e) I acknowledge that I have consulted with a physician and I have no health problems that would

preclude me from full and safe participation in Gracie Jiu-Jitsu.

f) With full knowledge and understanding of the aforementioned risks, both to myself and to my

property, and after having these dangers fully explained to myself and/or to my legal guardian:

_________________________ (Name of Legal Guardian if Under 18, please enter name below), I

nevertheless desire to participate in Gracie Jiu-Jitsu training activities.

g) Due to the nature of the activities conducted in Gracie Jiu-Jitsu classes, it would be

unreasonable for Gracie Global, LLC (d.b.a. Gracie University), Leisal LLC (d.b.a. Gracie Jiu-Jitsu

Alexandria) Virginia Dojo, LLC and/or the respective owners, directors and shareholders, agents

and employees to be in any way responsible for my injury (or death) and to the full extent of the

law I hereby waive my legal rights of action against and fully release the company of loss,

damages, injury or death however arising out of or in relation to my participation in the activitiesconducted or organized by the company including, without limitation, liability for any negligent

or tortious act or omission, breach of duty, breach of contract or breach of statutory duty on the

part of the company, its office bearers, directors, employees or agents.

h) I have and will maintain appropriate medical insurance during classes/training. I authorize any

emergency first aid, CPR, AEDs, medication, medical treatment, and/or emergency

transportation and I assume all costs involved in such treatment.

i) I understand that Gracie University, Gracie Jiu-Jitsu Alexandria, Virginia Dojo, reserves the right

to refuse service to any individual who has been convicted of a sex crime.

j) I will not video record or photograph any classes/training without prior permission from Gracie

University, Gracie Jiu-Jitsu Alexandria, and/or Virginia Dojo.

k) I am also aware that for purposes of safety, security and quality control there are surveillance

cameras mounted throughout Gracie University, Gracie Jiu-Jitsu Alexandria and Virginia Dojo.

Furthermore, I understand and acknowledge that video recordings or photographs may be taken

of me during classes/training. I hereby grand Gracie Global, LLC (d.b.a. Gracie University), Leisal,

LLC (d.b.a. Gracie Jiu-Jitsu Alexandria), Virginia Dojo, LLC the unlimited use of my likeness in any

format - photo, video, or other promotional advertisement or commercial use in any format know

or yet to be developed in perpetuity, and I forfeit any form of payment.

l) I agree that if any term of this agreement is to any extent illegal, otherwise invalid, or incapable

of being enforced, all other terms shall remain in full force and effect. I understand that this

agreement supersedes any and all previous oral or written agreements with regards to the

practice of Gracie Jiu-Jitsu and I give up substantial rights by signing it.