I,, understand that I am voluntarily participating in a class or event at Primus Grappling LLC and/or South Central PA Judo Foundation.

I acknowledge that activities such as Brazilian Jiu Jitsu, wrestling, striking, kickboxing, and general fitness involve physical contact and carry risks of injury, including but not limited to:

• Sprains, strains, or bruising

• Concussions or joint injuries

• Skin infections or illnesses

• Accidental falls or impacts

I confirm that I am in good health and fit to participate. I voluntarily assume all risks of injury or illness and release Primus Grappling LLC and South Central PA Judo Foundation, their staff, instructors, and affiliates from any and all liability.

Visitor Conduct & Hygiene

• Visitors must wear clean, appropriate training attire

• No bare torsos in training areas

• Fingernails must be trimmed; personal hygiene is expected

• Visitors under age 16 must be accompanied by a parent/guardian

• Locker room access is for individuals 16+ only

Photo / Media Opt-Out

I grant permission for my photo or video to be taken for promotional or educational use.

⬜ Check here if you DO NOT give permission for photos or video usage

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CLIENT NAME

If under 18:
Parent/Guardian Name: