Skip to content
Step
1
of
3
33%
Are you signing up or visiting?
Signing Up
Visiting
Student Information
You must be 18 years of age or older to complete the following requested information. Please read carefully and fill out to completion.
Responsible Party
(Required)
The account holder responsible for payments
First
Last
Address
(Required)
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Cell Phone
(Required)
Email
(Required)
Work Phone
Home Phone
Emergency Contact
Name
(Required)
First
Last
Phone
(Required)
Student Names
Students use the + sign to add multiple (if other than self)
First Name
Last Name
Birthday
Add
Remove
Medical History
Please list any current or pre-existing injuries or medical conditions including date of onset and student name if more than one student:
Use new line for each condition (+)
Add
Remove
WAIVER AND RELEASE OF LIABILITY
(Required)
BY CHECKING THIS BOX I AFFIRM THAT I AM OF THE AGE OF 18 YEARS OR OLDER, AND THAT I AM FREELY SIGNING THIS AGREEMENT. I CERTIFY THAT I HAVE READ THIS AGREEMENT, THAT I FULLY UNDERSTAND ITS CONTENT AND THAT THIS RELEASE CANNOT BE MODIFIED ORALLY. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND THAT I AM SIGNING IT OF MY OWN FREE WIL IN THE EVENT THAT THE PARTICIPANT IS UNDER THE AGE OF CONSENT (18 YEARS OF AGE), THEN THIS RELEASE MUST BE SIGNED BY A PARENT OR GUARDIAN, AS FOLLOWS: I HEREBY CERTIFY that I am the parent or legal guardian of minor, named below, and do hereby give my consent without reservation to the foregoing on behalf of this individual.
THIS AGREEMENT MUST BE SIGNED PRIOR TO PARTICIPATING IN ANY Human Artwork Jiu Jitsu TRAINING, CLASS, EVENT, COMPETITION, OR OTHER ACTIVITY (the “Activities”).
PLEASE READ THIS FORM CAREFULLY. Be aware that by signing this WAIVER, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK (the “RELEASE”), you, ON BEHALF OF YOURSELF AND YOUR MINOR CHILD OR WARD, IF APPLICABLE, will be expressly waiving and releasing all claims that you may have against Human Artwork Jiu Jitsu.
In consideration of being allowed to participate in any way in the Activities of Human Artwork Jiu Jitsu, I, the undersigned:
1. Certify that I am in good physical condition, and have no disease, injury, or other condition that would impair my performance or physical and mental well-being during the Activities. I have informed or will inform Human Artwork Jiu Jitsu of any conditions I have that may affect my ability to participate in the Activities and understand and agree that, in permitting me to participate in the Activities, Human Artwork Jiu Jitsu has relied on my representation that I am in good health. I understand that failure to disclose all medical conditions, ailments, and other issues further waives the Human Artwork Jiu Jitsu’s liability from any and all injuries or other outcomes related to my involvement in the Activities. If at any time I believe that I am unable to participate in the Activities due to physical or medical conditions, I will immediately discontinue participation and will notify Human Artwork Jiu Jitsu of such condition. If emergency medical treatment of me appears to be necessary during any Activity, I consent to such treatment by any local responders or caregivers, if available.
2. Recognize and understand that Brazilian Jiu-Jitsu training is an activity that is inherently dangerous and involves physical contact and that my participation might result in severe bodily injury, including, but not limited to, partial and/or total disability, paralysis, and death. Further, I recognize that the social and economic losses and/or damages that could result from these risks and dangers described above could be severe.
3. Recognize and understand that such risk may be due to not only my own actions but also the action, inaction, or negligence of others, the regulations of participation, or the conditions of the premises or of any of the equipment used.
4. Recognize that there may be other risks that are not known to me or to others or not reasonably foreseeable at this time.
5. Recognize that some of the Activities require close bodily contact that is not designed or intended to have a sexual nature, intent, or context.
6. Understand and agree that I use the equipment and the facilities “As Is” and at my own risk. I agree to inspect the facilities and equipment prior to participation. I will immediately inform an instructor if I believe that anything is unsafe or beyond my capability and refuse to participate. I understand and agree that if at any time, I feel anything is unsafe, I will immediately take all precautions to avoid the unsafe area and refuse to participate further.
7. Recognize and understand that in any activity involving a publicly accessible place and involving other people, there is a risk of exposure to bacteria, viruses, or other communicable diseases (including, without limitation, risks associated with COVID-19), toxins, parasites, or other adverse health factors. I agree to exercise reasonable care to minimize exposing others and assume the risk of exposure from others.
8. ASSUME ALL OF THE FOREGOING RISKS AND ACCEPT PERSONAL RESPONSIBILITY FOR ANY DAMAGES THAT MAY RESULT FROM INJURY, PERMANENT DISABILITY, OR DEATH.
9. Participate in the Activities entirely of my own free will.
10. RELEASE, WAIVE, DISCHARGE, AND COVENANT NOT TO SUE Human Artwork Jiu Jitsu, ITS AFFILIATED ORGANIZATIONS AND GOVERNING BODIES, THEIR OFFICERS, INSTRUCTORS, AND PERSONNEL, OTHER MEMBERS OF THE ORGANIZATIONS, PARTICIPANTS, SUPERVISORS, COACHES, SPONSORING ORGANIZATIONS OR THEIR AGENTS, AND IF APPLICABLE, OWNERS AND LESSORS OF THE PREMISES (HEREINAFTER REFERRED TO AS “RELEASEES”) FROM ANY AND ALL LIABILITY TO THE UNDERSIGNED, HIS OR HER HEIRS AND NEXT OF KIN FOR ANY AND ALL CLAIMS, DEMANDS, LOSSES, AND DAMAGES WHICH MAY BE SUSTAINED AND SUFFERED ON ACCOUNT OF INJURY, INCLUDING DEATH OR DAMAGE TO PROPERTY, CAUSED OR ALLEGED TO BE CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.
11. INDEMNIFY AND HOLD HARMLESS RELEASEES FROM ANY AND ALL LIABILITIES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS’ FEES) OR CLAIMS MADE BY THIRD PARTIES DUE TO MY ACTIONS OR INACTIONS DURING ANY ACTIVITIES. FURTHER, IF THE MINOR ON BEHALF OF WHOM I EXECUTE THIS RELEASE OR ANY OF MY FAMILY MEMBERS, RELATIVES, OR OTHER GUESTS MAKES A CLAIM AGAINST THE RELEASEES, THE UNDERSIGNED WILL INDEMNIFY AND HOLD HARMLESS THE RELEASEES FROM ANY AND ALL LIABILITIES AND EXPENSES (INCLUDING REASONABLE ATTORNEYS’ FEES) RELATED TO SUCH CLAIM. SHOULD THE RELEASEES INCUR ATTORNEYS’ FEES AND COSTS TO ENFORCE THIS RELEASE, I SHALL REIMBURSE TO TOTAL IMPACT ALL SUCH FEES AND COSTS.
12. Certify that I am at least 18 years of age. If under 18, my parent/guardian is the undersigned.
I HAVE READ THE ABOVE WAIVER, RELEASE OF LIABILITY, AND ASSUMPTION OF RISK. I FULLY UNDERSTAND ITS CONTENTS, AND I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT. I HEREBY SIGN IT VOLUNTARILY WITHOUT ANY INDUCEMENT, ASSURANCE, WARRANTY, OR GUARANTEE BEING MADE TO ME AND INTEND MY SIGNATURE TO BE A COMPLETE AND UNCONDITIONAL RELEASE OF ALL LIABILITY.
PRIVACY POLICY
(Required)
By CHECKING THIS BOX our membership contract, you acknowledge that you have read, understood, and agreed to this Privacy Policy and consent to the collection, use, and sharing of your personal information as described herein. If you do not agree with this Privacy Policy, please do not proceed with your membership application or contact us to discuss any concerns or questions.
**Section 1: Information We Collect**
We collect various types of information from our members to provide you with the best martial arts experience possible. The types of information we may collect include:
1. Personal Information: This may include your name, contact information (such as email address, phone number, and mailing address), date of birth, emergency contact information, and other details required for membership registration.
2. Health Information: To ensure your safety while participating in martial arts training, we may collect information about your health and any medical conditions or injuries that may affect your participation.
3. Billing Information: We collect payment and billing information, such as credit card details, to process membership dues and other related fees.
4. Training and Attendance Information: We keep records of your training sessions, attendance, and performance to track your progress and provide tailored martial arts instruction.
5. Photographs and Videos: We may take and use photographs and videos during martial arts classes or events for promotional and instructional purposes with your consent.
**Section 2: How We Use Your Information**
We use the information we collect for the following purposes:
1. Membership Management: We use your personal information to manage your membership, process payments, and communicate with you about our services and any updates or changes to your membership.
2. Safety and Instruction: Your health and training information help us provide a safe and effective training environment. We may use this information to tailor our instruction to your needs and ensure your well-being.
3. Promotional Activities: With your consent, we may use photographs and videos featuring your likeness for promotional activities, such as social media posts, website content, or marketing materials.
4. Legal Compliance: We may use your information to comply with applicable laws and regulations.
**Section 3: Information Sharing and Disclosure**
We do not sell or rent your personal information to third parties. However, we may share your information in the following circumstances:
1. Service Providers: We may share your information with third-party service providers who help us manage and operate our martial arts academy, process payments, and provide other essential services.
2. Legal Requirements: We may disclose your information when required by law, such as in response to a court order, subpoena, or other legal process.
3. Safety and Security: We may share your information to protect the safety and security of our members, staff, or others, or to investigate and prevent fraudulent or illegal activities.
**Section 4: Your Choices and Rights**
You have certain rights concerning your personal information, including the right to access, correct, or delete your information. You can also withdraw consent for promotional activities involving your likeness. To exercise these rights or for any questions or concerns regarding your personal information, please contact us at our direct line: (951) 501-6209.
**Section 5: Security**
We take reasonable measures to safeguard your personal information from unauthorized access, disclosure, or alteration. However, no method of transmission over the internet or electronic storage is completely secure, so we cannot guarantee absolute security.
**Section 6: Updates to this Privacy Policy**
We may update this Privacy Policy from time to time to reflect changes in our practices or for legal or regulatory reasons. We will notify you of any significant changes by posting an updated Privacy Policy online or by other appropriate means.
By signing our membership contract, you acknowledge that you have read, understood, and agreed to this Privacy Policy and consent to the collection, use, and sharing of your personal information as described herein.
If you do not agree with this Privacy Policy, please do not proceed with your membership application or contact us to discuss any concerns or questions.
LEGAL NOTICE: RATES, PAYMENTS, AND REFUNDS
(Required)
I consent to the membership agreement below
LEGAL NOTICE: RATES, PAYMENTS, AND REFUNDS
MEMBERSHIP DURATION
For the purpose of this document, a membership duration spans a period of one (1) month. It should be noted that memberships are subject to automatic renewal at the conclusion of each membership term. HumanArtwork Jiu Jitsu retains the prerogative to modify the fee schedule for memberships without prior notice.
CANCELLATION OF MEMBERSHIP
Should you wish to terminate your training regimen, whether temporarily or permanently, you are hereby made aware that it is incumbent upon you to provide a written notice to HumanArtwork Jiu Jitsu with no less than thirty (30) days advanced notice preceding the intended cancellation or suspension.
ADJUSTMENTS TO MEMBERSHIP FEES
Payments are facilitated at the inception of each membership period. The initial month of enrollment, inclusive of the Registration Fee, will be prorated in such a manner as to ensure that subsequent payments align with the first day of each month. The effectuation of payments for ensuing periods will function as an extension of your membership agreement and shall indicate your ongoing acceptance of the terms delineated herein. It is important to emphasize that membership fees are nonrefundable. Delinquent tuition shall incur a penalty fee of $15, and any checks returned unpaid will incur a penalty fee of $25. It is incumbent upon me to ensure the punctual reception of my payments. In the event of any alteration in my chosen method of payment, encompassing credit card, bank account, or any other form of remittance, I commit to notifying HumanArtwork Jiu Jitsu at least fifteen (15) days in advance of the subsequent billing cycle to forestall the imposition of penalties.
MEMBERSHIP PAYMENT REMINDERS
HumanArtwork Jiu Jitsu does not undertake to dispatch reminders concerning impending payments. The affirmation of payment shall be conferred by means of your credit card or bank account statement, serving as definitive confirmation of receipt.
FAMILY ADD-ON MEMBERSHIPS
Pursuant to the Fee Schedule, patrons who opt for Family Add-on Memberships shall be entitled to a discounted rate. These preferential rates shall hold valid so long as one family member is enrolled at the standard rate. The prevailing standard rate shall be applicable to the primary membership, while the equivalent or lower rate shall pertain to the Family Add-on Membership. In the event of the cancellation of the standard membership, the Add-on rate shall be adjusted to align with the standard membership rates.
ALTERATIONS TO MEMBERSHIP RATES
It is imperative to acknowledge that membership rates remain susceptible to modification. Any modifications to the rates will be communicated in written form and shall be prominently displayed on the official HumanArtwork Jiu Jitsu website, located at www.HumanArtworkjj.com, with a minimum notice period of forty-five (45) days prior to the intended implementation. The revised rates shall be enforced upon the renewal date of the member, following the conclusion of the 45-day notification period.
RIGHT OF RESCISSION FOR PURCHASERS
Should you entertain the desire to rescind this agreement, you may execute such a course of action by forwarding an email communication to info@humanartwork.com. The content of said communication must unequivocally express your intention to sever your affiliation with this agreement and nullify your membership. Additionally, it is imperative to acknowledge that any equipment supplied shall be subject to charges to the BUYER, pertaining to the cost of utilized gear.
CLASS TIMETABLE
The standard timetable for classes shall be conspicuously posted on www.HumanArtworkjj.com. It is within the purview of HumanArtwork Jiu Jitsu to introduce either temporary or permanent adjustments to the schedule without the compulsion of prior notice, and this prerogative may be exercised for any rationale deemed appropriate.
SUPPLEMENTAL EXPENSES
Incidental expenditures associated with uniforms, equipment, seminars, camps, private lessons, and similar undertakings shall be regarded as separate costs and are not encompassed within the ambit of tuition or registration fees. The sole obligatory item of equipment for Brazilian Jiu-Jitsu, the uniform (Gi), may be procured through HumanArtwork Jiu Jitsu or other vendors. It is advisable to solicit further details from your instructor concerning the requisites pertaining to the uniform.
By selecting a membership plan and affixing my signature hereto, I affirm my understanding and comprehension of the provisions within this Membership Agreement. Furthermore, I confirm that I have perused the Liability Waiver Form and have received a copy thereof. The contents of this agreement, inclusive of all associated information, shall be conserved in a secure repository within the confines of the HumanArtwork Jiu Jitsu establishment, unless the terms and conditions therein experience modification, at which point a fresh agreement shall be executed. All credit card information, in its entirety, shall be expunged following its entry into our billing system.
Payment Authorization Information and Agreement
Product Name
The payment information provided below, is to be utilized for the following student(s) account(s) (ONE STUDENT PER LINE PLEASE)::
(Required)
ADD ADDITIONAL LINE WITH THE (+) SYMBOL
FIRST NAME
LAST NAME
Add
Remove
Credit Card
American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number
Expiration Date
Month
Month
01
02
03
04
05
06
07
08
09
10
11
12
Year
Year
2024
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
2038
2039
2040
2041
2042
2043
Security Code
Cardholder Name
Consent
(Required)
I agree to the terms of the payment authorization agreement and 4% payment services fee
By providing my signature below, I, the Account Holder, hereby acknowledge, that as the financially responsible
party for this Student/Member account, I have received a copy of this Payment Agreement & Authorization of
Automated Payments. I, the Account Holder acknowledge that my payment method will be kept on file by the
School for future payments, such as membership dues and/or gear I have or may request to order directly through
the School.
Signature
Go to Top