Dragon Judo Academy · Riverview, Florida

Liability Waiver & Photo Release

Complete this form before stepping on the mat. Parents or guardians must sign for students under 18.

All students at Dragon Judo Academy must complete a liability waiver before participating. This form also includes an optional photo and video release. Classes are hosted at Gracie Brandon; additional facility rules may apply on site.

Student Information

Student full name

Date of birth

Student is under 18 (parent/guardian must sign)

Phone

Emergency contact name

Emergency contact phone

Liability Waiver and Assumption of Risk

I understand that judo and related martial arts training at Dragon Judo Academy involve physical contact, falling, throwing, grappling, and other activities that carry an inherent risk of injury, including but not limited to strains, sprains, bruises, fractures, concussions, and in rare cases serious injury or death.

I voluntarily assume all risks associated with participation, whether known or unknown, including risks arising from the acts or omissions of other participants, instructors, or the condition of the training facility.

I release, waive, and discharge Dragon Judo Academy, its instructors (including Sensei Javier Siles), owners, employees, agents, and the host facility (including Gracie Brandon) from any and all claims, liabilities, or damages arising from my (or my child's) participation, to the fullest extent permitted by Florida law. This release does not waive liability for gross negligence or willful misconduct where such waiver is prohibited by law.

I agree to follow all safety instructions, facility rules, and coaching directions. I confirm that I (or my child) am physically able to participate, and I will inform the instructor of any relevant medical conditions or injuries.

I understand that this waiver is binding on me, my heirs, and my legal representatives, and that I have had the opportunity to ask questions before signing.

I have read and agree to the Liability Waiver and Assumption of Risk.

Photo and Video Release

I grant Dragon Judo Academy permission to photograph and/or record video of me (or my child) during classes, events, and related activities, and to use those images and recordings for legitimate academy purposes, including the website, social media, print materials, and promotional content.

I understand that no compensation will be provided for such use, and that I may withdraw future photo/video consent by contacting the academy in writing. Withdrawal does not require removal of materials already published in good faith before notice was received.

I grant photo and video release permission as described above.

Leave unchecked if you prefer not to appear in photos or videos. You can also email dragonjudoacademy@gmail.com anytime to update this preference.

Optional: send me class reminders, schedule updates, and occasional academy news by email or text. I can opt out anytime.

Electronic Signature

By typing my name below and submitting this form, I agree that my electronic signature is the legal equivalent of my handwritten signature under applicable law, including the Florida Electronic Signature Act and the federal E-SIGN Act.

Type your full name to sign

Date

Submitting this form also confirms you have read our Terms of Service, Privacy Policy, and Refund Policy. This online waiver is a convenience; the academy may also require facility-specific paperwork at Gracie Brandon.