Republic Jiu-Jitsu – Participant Registration & Waiver Form (2025)
Participant Information
Name: ___________________________________________
Date of Birth: ____________________________________
Address: _________________________________________
Phone Number(s): _________________________________
Emergency Contact (Name & Relationship): ____________________
Emergency Contact Phone #: _________________________
Medical Information (Confidential)
Please disclose any conditions that may impact safe participation:
• Allergies
• Communicable diseases
• Physical impairments
• Chronic conditions (e.g., diabetes)
• Mental health considerations
• Special dietary requirements
• Pregnancy
Note: This information will remain confidential except in a medical emergency.
Republic Jiu-Jitsu Rules & Safety Standards
• Treat all members with respect and courtesy.
• No jewellery, watches, or piercings on the mats. Hair must be tied back.
• Students must wear a clean gi or approved attire at all times.
• No shoes on mats. Sandals must be worn when leaving the mat area.
• Finger and toenails must be trimmed.
• No slams, strikes, eye gouging, or groin attacks.
• No small joint manipulation (fingers/toes).
• Leg locks and submissions must follow IBJJF standards for age and belt level.
• Heel hooks and reaping are prohibited for participants under 18.
• Strive to protect your partner—tap early and release quickly.
• Aggressive or unsafe behaviour may result in expulsion.
Waiver of Liability
This is a legally binding liability release and waiver. Martial arts, including Brazilian Jiu-Jitsu, carry
inherent risks of injury. By signing below, I acknowledge these risks, including but not limited to sprains,
fractures, concussions, and other injuries. I release Republic Jiu-Jitsu, its instructors, agents, and
members from any and all liability, claims, or actions arising from injury, illness, or damages incurred
while participating in training, tournaments, seminars, or related activities, whether caused by
negligence or otherwise. This waiver is binding upon me, my heirs, executors, and assigns. This
agreement is governed by the laws of Newfoundland and Labrador.
This document may affect your legal rights
Please read the entire document carefully before signing it
Liability release, waiver, discharge and covenant not to sue
This is a legally binding liability release, waiver, discharge and covenant not to sue
(the “Release”), made by me, the undersigned, to the Republic Jiu-Jitsu Club at St
John’s Newfoundland (the “Club”), to the instructors of the Club (the “Instructors”),
and to the members of the Club (the “Members”). I fully recognize that there are
dangers and risks to which I may be exposed by joining the Club and participating in
jiu-jitsu, which is a martial art and involves strenuous physical activity and extensive
physical contact with other people and a mat, including but not limited to joint locks,
throws, chokes, unintentional or accidental strikes, ground fighting, and other similar
activity. With full understanding of the risks involved and despite this Release, I am
voluntarily joining the Club and I am willing to participate in Jiu-Jitsu. I therefore
agree to assume and take upon myself all of the risks and responsibilities in any
way associated with this activity. In consideration of and in return for services,
facilities, and other assistance provided to me by the Club, the Instructors and the
other Members in this activity, I release the Club, its agents, the Instructors and the
Members from any and all liability, claims and actions that may arise from injury or
harm to me, from my death or from damage to my property in connection with this
activity. I understand that this Release covers liability, claims and actions caused
entirely or in part by any acts or failures to act by the Club, its agents, the
Instructors and the Members, including but not limited to negligence, mistake, or
failure to supervise. I recognize that this Release means I am giving up, among
other things, rights to sue the Club, its agents, the Instructors and the Members for
injuries, damages, or losses I may incur while participating in this activity. I also
understand that this release binds my heirs, executors, administrators, and assigns,
as well as myself. I have read the entire Release; I fully understand it and I agree to
be legally bound by it.
This is a release of your rights, read carefully before signing
I certify that the information provided in this application is true and accurate.
Parent/Guardian Consent (if participant is under 18)
I am the parent/legal guardian of the participant and consent to their participation under the same
terms.
Photo/Video Release
I consent / do not consent to Republic Jiu-Jitsu using photos or videos of me/my child for promotional
purposes, including the Republic website, social media platforms, and newsletters. I understand no
compensation will be provided for such use.
Participant Signature: _______________________________ Date: ___________
Parent/Guardian Signature (if under 18): _______________ Date: ___________
