Student Release & Waiver

I understand that martial arts and/or fitness is a contact and physical sport/activity and that my (or my child's) participation in this activity and event(s) involves risk of physical injury including death. I acknowledge and accept the risk of all physical injury including death that may result from my (or my child's) participation in this/these activity/activities.

In consideration of my (or my child’s) registration in Rollstar LLC (Rollstar Brazilian Jiu Jitsu), I hereby, for myself (or my child’s), and on behalf of my heirs, executors or administrators, waive and release any and all rights and claims for damages I may have against and covenant to sue Rollstar LLC, its instructors and sponsors, their employees, officers, directors, and agents for any and all injuries suffered arising out of, or connected to this activity and event(s) whether caused in whole or in part by the negligence of those released therein.

I have been advised that, due to the strenuous nature of some of the activities, I should consult with my (or my child’s) physician concerning my (or my child’s) fitness participation. To the best of my knowledge there are no physical or other conditions which will interfere with my (or my child’s) participation in this martial arts program.

I (or my child) understand(s) that Rollstar LLC, Brazilian Jiu Jitsu and Fitness, classes are solely for the purpose of exercise and maintaining a healthy lifestyle. The exercise, drills and self-defense techniques practiced at Rollstar Brazilian Jiu Jitsu and Fitness are for educational and fitness purposes only.  In no way does Rollstar LLC promote or condone the use of martial arts for violence against any individuals, groups or communities under any circumstances.

Name of Student *
Name of Student
Date of Birth *
Date of Birth
Parent or Guardian (Students Under 18)
Parent or Guardian (Students Under 18)
Please list an emergency contact name if it is NOT listed above.
Emergency Phone Number *
Emergency Phone Number
Agreement & Approval *
Do you agree and understand the terms and conditions described in this waiver?