Register for Program

INFORMED CONSENT FOR PARTICIPATION, ACKNOWLEDGEMENT AND WAIVER OF LIABILITY, ACKNOWLEDGMENT OF ASSUMPTION OF THE RISK, AND INDEMNITY AGREEMENT

Requirement of Agreement:

This Informed Consent, Acknowledgement and Waiver of Liability, Acknowledgment of Assumption of the Risk, and Indemnity Agreement must be signed by all students and participants and/or their legal guardians before the student or participant may participate in events or classes of any kind, including but not limited to classes, open mats, competitions, seminars, private training sessions, or any other activity sponsored by or taking place at the facilities of Karl Chodakiewitz

Description of Terms: 

MMA and Self-Defense: MMA and Self-Defense refers to mixed martial arts techniques that include but are not limited to punches, kicks, knee strikes, elbow strikes, trips, foot sweeps, and floor grappling for self-defense, physical conditioning, recreation and competitive combat sports. . The practice of MMA and Self-defense includes physical contact which involves a risk of injury and illness, up to and including paralysis and death. These conditions are an inherent risk of participating in MMA and Self-defense. There may be moves utilized with which Student is unfamiliar. Eliminating moves fundamentally alters the nature of MMA and Self-Defense, and can fundamentally change the sport or discourage participation. Giborim encourages Students to learn about the history of MMA and Self-Defense, and to study both on and off the training facility. Giborim further encourages Students to learn how to reduce the risk of injury both in their practice and through physical fitness and health programs which can assist in the reduction of injuries.

“Activity” as used herein includes classes, open mats, events, competitions, seminars, private training sessions, or any other activities or events sponsored by Karl Chodakiewitz or taking place at the facilities of Karl Chodakiewitz, including but not limited to MMA, any martial art, self-defense, or events sponsored by Karl Chodakiewitz and sponsoring organization or individual hosting Giborim events at their premises and homes

Parties: Karl Chodakiewitz (referred to herein as “Giborim” and “Kalman Chodakiewitz”) includes Giborim owners, employees, agents, instructors (also known as professors), guest instructors, staff, officers, directors, representatives, independent contractors, and seminar leaders. “Student” and “Participant” as described herein includes the undersigned student(s), participant(s), child or children, guests, invitees, and any legal guardian(s) of the student or participant in classes, events, open mats, competitions, seminars, private training sessions, or any other activity sponsored by Giborim or taking place at the facilities of Giborim. Where a parent or legal guardian is signing on behalf of minor(s), Student or Participant includes all minor children of the undersigned parent or legal guardian participating in any Activity. “Student” and “Participant” also includes applicants, guests, invitees, and their respective guardians.

1. The undersigned Student {name} represents and warrants that (s)he is in good health and has no physical or mental disability, impairment or pre-existing condition that may otherwise prevent him/her from safely participating in the listed program’s activities. Student acknowledges the advice of Giborim that everyone should receive a physical examination prior to participating in any strenuous physical activity, including those held at Giborim. Student understands that the activities involved in the listed program are physically strenuous, violent, and potentially dangerous and may expose him/her to serious physical injury. Student further agrees to immediately notify Giborim management in the event that conditions change during the course of his/her membership for any reason (i.e., accident, illness, or other medical condition).

1. Physical contact will be used by professors and instructors or guest instructors of the school, other students, and authorized individuals, as part of the course of instruction. Student has been advised of such facts and gives full consent to any physical contact as may be required or customary to MMA and Self-Defense training.

1. WAIVER: STUDENT, APPLICANT, OR INVITEE (I.E., GUEST, FREE CLASS PASS, TRIAL MEMBER, COUPON USER, ETC.) AND/OR THEIR RESPECTIVE PARENTS/GUARDIANS (FOR APPLICANTS/STUDENTS/INVITEES UNDER 18 YEARS OF AGE), IN CONSIDERATION FOR STUDENT’S PARTICIPATION IN ACTIVITIES ADMINISTERED BY GIBORIM, INCLUDING OWNERS, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, REPRESENTATIVES, CONTRACTORS, AND SUB-CONTRACTORS, VOLUNTEERS (“STAFF”), GUEST INSTRUCTORS, AND PREMISES OWNER, DOES HEREBY EXPRESSLY WAIVE RELEASE AND FOREVER DISCHARGE GIBORIM FROM ANY AND ALL LIABILITY FOR ANY PERSONAL INJURIES OR DAMAGES UP TO AND INCLUDING PARALYSIS OR DEATH RESULTING FROM STUDENT PARTICIPATION IN ANY OF THE LISTED PROGRAMS’ ACTIVITIES, EITHER ON OR OFF THE FACILITY’S PREMISES, INCLUDING THOSE DUE TO ANY INTENTIONAL OR UNINTENTIONAL ACT OF GIBORIM, TO THE FULLEST EXTENT PROVIDED BY LAW. 

2. Acknowledgement of Inherent Risks: By signing below, Student acknowledges they are voluntarily participating in the Activity.  Student acknowledges they are aware of the risks associated with participating in this Activity and traveling to and from the Activity, which include but are not limited to physical or psychological injury, pain, suffering, illness, disfigurement, temporary or permanent disability, paralysis, economic or emotional loss, and/or death.  Student understands that these injuries or outcomes may arise from their own or other’s actions, inaction, or negligence; unreasonable risks taken,  conditions related to travel; or the condition of the Activity location(s). Student understands there may be instances where the risks inherent in the Activity are unreasonably increased. Nonetheless, Student assumes all related risks, reasonable or unreasonable, both known or unknown to Student, of participation in the Activity, and travel to, from and during the Activity.

3. Hold Harmless: Student agrees to hold GIBORIM harmless from any and all claims, including economic or non-economic damages including but not limited to personal injuries, medical damages, lost earnings, emotional distress, damage to personal property, attorney’s fees, which may occur as a result of Student’s participation in Activity as defined herein and/or GIBORIM events, including travel to, from and during events. This hold harmless agreement includes claims based on actions of third-party participants, such as claims arising from the acts of other students.

4. The undersigned affirms they are 18 years or older.  Student/the undersigned understands the legal consequences of signing this document, including (a) releasing Karl Chodakiewitz and GIBORIM from all liability, and (b) assuming all risks of participating in this Activity, including travel to, from and during the Activity. Persons under the age of 18 may not participate in any Activity without a signed informed consent agreement from a parent or legal guardian of the Student. By signing below the undersigned warrants they have the legal capacity to sign this document. Where signing on behalf of minor(s) or a child/children, they warrant they have the legal capacity to sign on behalf of the minor(s) or child/children. 

5. By signing below, Student acknowledges they have read and understand the Waiver of Liability and agree to abide by it. 

6. Student further acknowledges that they may be photographed or filmed while attending at the premises of Karl Chodakiewitz, and Student gives permission to Karl Chodakiewitz, and any affiliates to use any and all photos, video footage, and/or video streaming for promotional, sales, publicity, and advertising purposes for all media including internet. 

9. Indemnity: Should Karl Chodakiewitz and or Giborim incur damages as a result of the negligence of Student, Student agrees to defend and indemnify Giborim for Student’s negligence including, but not limited to, payment of attorney fees and damages. This indemnity agreement includes claims based on actions of third party participants, such as claims arising from the acts of other students.

1. Student understands that this document is written to be as broad and inclusive as legally permitted by the State of California.  If any portion is held invalid or unenforceable, Student will continue to be bound by the remaining terms. Student has read this document and is signing it freely.  No other representations concerning the legal effect of this document have been made.

2. COVID-19: The waiver of liability is understood to include special COVID-19 related items. The undersigned acknowledges that the disease caused by the novel coronavirus (COVID-19) has been confirmed throughout the United States. In accordance with the most recent guidance and protocols issued by the Centers for Disease Control and Prevention (CDC) and the state Department of Health for slowing the transmission of COVID-19, the undersigned and Student hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs (other than any online services) within 14 days after (i) returning from a highly impacted area subject to CDC Level 3 Travel Health Notices, (ii) exposure to any person returning from areas subject to a CDC Level 3 Travel Health Notice, or (iii) exposure to any person who has a suspected or confirmed case of COVID-19. The complete CDC Travel Health Notice is continuously updated at https://www.cdc.gov/coronavirus/2019-ncov/travelers/map-and-travel-notices.html and the undersigned agrees that they are aware of this list and the countries listed.

3. The undersigned Student hereby agrees, represents, and warrants that neither the undersigned nor such participating children shall visit or utilize the facilities, services, and programs (other than any online services) if he or she (i) experiences symptoms of COVID-19, including cough, shortness of breath or difficulty breathing, fever, or new loss of taste or smell, or (ii) has a suspected or diagnosed/confirmed case of COVID-19. The undersigned agrees to notify us immediately if he or she believes that any of the foregoing access/use restrictions may apply.

4.  Giborim has taken certain steps to implement recommended guidance and protocols for slowing the transmission of COVID-19, including, without limitation, the access/use restrictions set forth above. The undersigned acknowledges and agrees that we may revise those procedures at any time based on updated guidance and protocols and further agrees to comply with the revised procedures prior to utilizing our facilities, services, or programs (other than any online services).

5. In further consideration of being permitted to enter our facility for any purpose including, but not limited to, observation or use of facilities or equipment, or participation in any  program, the undersigned Student hereby agrees to the following:

1. The undersigned, on his or her behalf, and on the behalf of such participating children, hereby releases, waives, and discharges Giborim, its directors, officers, employees, volunteers and agents from all liability to the undersigned or such participating children for any loss or damage, and agrees not to sue Karl Chodakiewitz for any claim or demands on account of any personal injury or property damage or illness or the death of, the undersigned or such participating children (or any person who may contact COVID-19, directly or indirectly, from the undersigned or such participating children) whether caused by negligence, active or passive, of Giborim or otherwise while the undersigned or such participating children are in, upon, or about the premises.

2. The undersigned hereby agrees to indemnify and save and hold harmless Karl Chodakiewitz, Giborim, its directors, officers, employees, volunteers and agenda, and each of them, from any loss, liability, damages or costs they may incur, whether caused by the negligence, active or passive, or otherwise while the undersigned or any participating child is in, upon, or about the premises of Giborim  

ACKNOWLEDGEMENT AND RELEASE FORM (WAIVER OF LIABILITY)

I HAVE CAREFULLY READ AND VOLUNTARILY SIGN THIS ASSUMPTION OF RISK, RELEASE AND WAIVER OF LIABILITY, AND INDEMNITY AGREEMENT AND FURTHER AGREE THAT NO ORAL REPRESENTATIONS, STATEMENTS OR INDUCEMENT APART FROM THE FOREGOING WRITTEN AGREEMENT HAVE BEEN MADE. I AM AWARE THAT BY AGREEING TO THIS AGREEMENT, I AM GIVING UP VALUABLE LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES FROM GIBORIM IN CASE OF ILLNESS, INJURY, DEATH OR PROPERTY LOSS OR DAMAGE, INCLUDING, FOR THE AVOIDANCE OF DOUBT AND WITHOUT LIMITATION, EXPOSURE TO COVID-19 AND ANY ILLNESS, INJURY, OR DEATH. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS. IF SIGNING ON BEHALF OF A MINOR, I ALSO UNDERSTAND THAT THIS AGREEMENT IS MADE ON BEHALF OF MY MINOR CHILD(REN) AND/OR LEGAL WARDS AND I REPRESENT AND WARRANT THAT I HAVE FULL AUTHORITY TO SIGN THIS AGREEMENT ON BEHALF OF SUCH MINOR(S).

{name}

Karl Chodakiewitz, Giborim Instructor and Founder, Giborim

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