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WAIVER OF LIABILITY(Initial on line to confirm you have read and understand written statements)
_____________ I understand that participation in martial arts or Brazilian Jiu Jitsu poses a possible inherent risk
of injury (minimal to severe, including death). I hereby assume all risks associated with participation in martial
arts or Brazilian Jiu Jitsu agree to hold the Khalil Nasir, instructors, assistant instructors, and employees
harmless from any and all liability that may arise in connection with my participation or my child’s participation
in the programs.
_____________I hereby certify that I/my child/my ward are in good health and have/has no physical limitations
that would preclude participation in martial arts activities or yoga.
_____________I certify that I/my child has health, accident and liability insurance to cover any bodily injury or
property damage that may because or suffered while participating in martial arts or yoga training, or else I
agree to bear the costs of such injury or damage to me/my child. I further certify that I am willing to assume the
risk of any medical or physical condition I/my child may have or am willing to assume and bear the costs if all
risks that may be created, directly or indirectly, by any such condition.
_____________ Further, I hereby voluntarily release and forever discharge and agree to hold harmless and
indemnify Khalil Nasir, its members, instructors, assistant instructors, employees, students, successors, lessors,
insurers, and representatives from any and all liability, claims, demands, causes of action or rights of action for
injury or damage resulting from my participation or my minor child’s or ward’s participation in Brazilian Jiu Jitsu
and martial arts programs equipment and facilities. This wavier is binding on my assigns, successors, heirs,
spouse, parents, administrators, guardians, insurers and legal representatives. ______________I agree that, if I
were to file a lawsuit against any of the listed parties, I would do so solely in North Carolina and that the
substantive law of the State of North Carolina shall apply without regard to North Carolina’s conflict of law
rules. I further agree that if any portion of this waiver agreement is found void or unenforceable, the remaining
portions shall remain in full force and effect. This waiver of liability is the entire, complete, sole, and only
understanding and agreement by and between the undersigned and Khalil Nasir, Kareem Glover, Yusuf
Shamsid-Deen to the above discussed matters.
BY SIGNING THIS ENROLLMENT APPLICATION AND WAIVER OF LIABILITY, THE UNDERSIGNED DOES HEREBY
ACKNOWLEDGE AND WARRANT THAT:
This waiver of liability was read carefully in its entirety, and is fully understood and known to be a full waiver of
liability as set forth above. I further agree to the policies put forth by Khalil Nasir in the Enrollment Application,
and warrant that I am over 18 years of age as of the date stated below, or that I am fully and legally
emancipated.