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MOJO DOJO MMA

MEMBERSHIP AGREEMENT, LIABILITY WAIVER, MEDICAL AUTHORIZATION & AUTOMATIC PAYMENT AGREEMENT

ONE TEAM, ONE FAMILY — DISCIPLINE AND RESPECT

Academy Address: 2 Pennsylvania Ave, Matamoras, PA 18336

Phone: 570-483-8130

Website: www.mojodojomma.com

SECTION 1: MEMBER INFORMATION

Full Legal Name: {name}

First Name: {first_name}

Date of Birth: {dob}

Residential Address: {address}

Phone Number: {phone}

Emergency Contact: {contact_name}

Emergency Contact Phone: {contact_phone}

Emergency Contact Relationship: {contact_relation}

Parent or Legal Guardian Name (if member is under 18):

Relationship to Minor:

SECTION 2: ACKNOWLEDGMENT OF INHERENT RISKS

I understand and acknowledge that participation in Brazilian Jiu-Jitsu (BJJ), No-Gi grappling, mixed martial arts, wrestling, submission grappling, self-defense, fitness conditioning, sparring, and related activities involves inherent and potentially serious risks.

These risks include, but are not limited to:

• Bruises, cuts, abrasions, and muscle strains.
• Sprains, dislocations, torn ligaments, and broken bones.
• Neck, back, spinal cord, and joint injuries.
• Head injuries, concussions, and traumatic brain injuries.
• Choking, unconsciousness, and injuries from submission holds.
• Injuries resulting from throws, takedowns, sweeps, and falls.
• Accidental physical contact with training partners, instructors, or equipment.
• Exposure to communicable diseases, illnesses, or skin infections.
• Cardiovascular emergencies, permanent disability, paralysis, and death.

I understand that injuries may occur even when reasonable safety precautions, instruction, and supervision are provided.

I voluntarily accept the inherent risks associated with participation in these activities.

Member/Guardian Initials:

SECTION 3: VOLUNTARY PARTICIPATION AND ASSUMPTION OF RISK

I acknowledge that my participation, or my child’s participation, in martial arts activities at Mojo Dojo MMA is voluntary.

I understand that Brazilian Jiu-Jitsu is a full-contact martial art involving physical resistance, pressure, joint manipulation, submission techniques, and close physical interaction.

I agree to follow instructor directions, communicate injuries or limitations, and exercise reasonable care toward other participants.

I understand that I may stop training, refuse a particular drill, or withdraw from an activity if I believe continuing would be unsafe.

I voluntarily assume the inherent risks of these activities.

Member/Guardian Initials:

SECTION 4: RELEASE OF LIABILITY — ADULT PARTICIPANTS

IMPORTANT: THIS SECTION AFFECTS YOUR LEGAL RIGHTS.

If I am 18 years of age or older, I expressly release and discharge Mojo Dojo MMA, its legal operating entity, owners, instructors, coaches, employees, volunteers, and agents from claims for injuries, illness, death, or property damage arising from participation in academy activities, including claims resulting from the ordinary negligence of the released parties, to the fullest extent permitted by Pennsylvania law.

This provision is intended to include ordinary-negligence claims concerning instruction, supervision, equipment, training activities, and premises conditions.

This release does not apply to reckless or intentional misconduct or liability that cannot legally be waived.

I understand that by signing this agreement, I may be giving up my right to recover compensation for certain injuries caused by ordinary negligence.

This section applies only to adult participants and does not purport to waive a minor participant’s independent legal rights.

Adult Participant Initials:

SECTION 5: MEDICAL ACKNOWLEDGMENT AND HEALTH RESPONSIBILITIES

I acknowledge that martial arts training requires physical exertion and that I am responsible for evaluating my ability to participate safely.

I agree to inform academy staff about relevant medical conditions, restrictions, injuries, allergies, or other circumstances affecting my participation.

I understand that Mojo Dojo MMA personnel are not acting as my medical providers and cannot guarantee my medical fitness.

Relevant Medical Conditions:

Allergies:

Current Medications Relevant to Emergency Care:

Physical Restrictions or Previous Injuries:

I agree to discontinue participation and seek appropriate medical attention if I experience symptoms or injuries that make continued participation unsafe.

Member/Guardian Initials:

SECTION 6: EMERGENCY MEDICAL AUTHORIZATION

In the event of an injury, illness, or medical emergency, I authorize Mojo Dojo MMA personnel to contact emergency medical services and assist in arranging appropriate emergency medical care.

For a minor participant, the signing parent or legal guardian authorizes emergency medical evaluation and treatment when immediate action is necessary and the parent or guardian cannot reasonably be contacted.

I understand that I or the legally responsible party may be responsible for medical costs arising from emergency evaluation, transportation, and treatment, subject to applicable law and insurance coverage.

Member/Guardian Initials:

SECTION 7: ACADEMY RULES AND CODE OF CONDUCT

All members are expected to demonstrate discipline, respect, sportsmanship, and responsibility.

I agree to comply with the following rules:

1. Follow all reasonable instructions given by authorized instructors.
2. Immediately release a submission when a partner taps, verbally submits, or an instructor directs.
3. Refrain from reckless, malicious, or intentionally harmful techniques.
4. Respect all students, instructors, parents, and visitors.
5. Maintain good hygiene and wear clean training uniforms.
6. Remove jewelry and hazardous accessories before training.
7. Report injuries and unsafe conditions promptly.
8. Avoid bullying, harassment, intimidation, and discriminatory behavior.
9. Do not participate while impaired by alcohol or drugs.
10. Use appropriate control and restraint during all training activities.

I understand that violating academy rules may result in disciplinary action, suspension, or termination of membership, subject to applicable contractual and legal rights.

Member/Guardian Initials:

SECTION 8: COMMUNICABLE ILLNESSES AND SKIN INFECTIONS

I understand that Brazilian Jiu-Jitsu involves close physical contact and may result in exposure to contagious illnesses or infections.

I agree not to participate in training while experiencing a contagious condition that may endanger others, including untreated ringworm, impetigo, or other transmissible skin infections.

I understand that academy personnel may reasonably restrict participation pending appropriate medical clearance when a health or safety concern exists.

I agree to follow academy hygiene and sanitation requirements.

Member/Guardian Initials:

SECTION 9: PERSONAL BELONGINGS AND PROPERTY RESPONSIBILITY

I acknowledge that I am responsible for securing and monitoring personal belongings brought onto Mojo Dojo MMA premises.

This includes, but is not limited to, phones, wallets, cash, electronics, jewelry, clothing, uniforms, equipment, bags, and other valuables.

Mojo Dojo MMA does not guarantee the security of personal belongings and is not responsible for ordinary losses unrelated to its negligence or misconduct, to the fullest extent permitted by applicable law.

Nothing in this agreement excludes liability that cannot legally be waived.

I also agree to respect academy property and understand that intentional damage or theft may result in responsibility for legally recoverable damages.

Member/Guardian Initials:

SECTION 10: MINOR PARTICIPATION AND PARENT/GUARDIAN AUTHORIZATION

If the participant is under 18 years of age, I represent that I am the minor’s parent or legally authorized guardian.

I authorize the minor to participate in age-appropriate martial arts training at Mojo Dojo MMA, including Brazilian Jiu-Jitsu, grappling, supervised drilling, conditioning, and self-defense activities.

I acknowledge that these activities involve inherent risks of injury and that I have reviewed the risks outlined in this agreement.

I agree to provide accurate emergency contact information and disclose relevant medical conditions or restrictions.

I understand that signing this agreement does not waive the minor’s independent legal claims or rights and does not bind a nonsigning parent or guardian.

Parent/Guardian Name:

Relationship to Minor:

Parent/Guardian Initials:

SECTION 11: MEMBERSHIP TERMS AND PARTICIPATION

I understand that my membership provides access to the classes and services associated with my selected membership plan, subject to academy schedules, rules, and applicable membership terms.

I understand that class schedules, instructors, and programs may change as reasonably necessary for academy operations.

Membership charges, billing frequency, and applicable membership terms must be disclosed and accepted before recurring billing begins.

Changes to membership pricing or material billing terms will be communicated in accordance with applicable law and the membership agreement.

I acknowledge that my membership remains active until properly canceled or terminated according to the applicable membership terms and legal requirements.

Member/Guardian Initials:

SECTION 12: GOVERNING LAW AND SEVERABILITY

This agreement shall be interpreted in accordance with the laws of the Commonwealth of Pennsylvania, subject to applicable mandatory laws and jurisdictional requirements.

If any provision is determined to be invalid or unenforceable, the remaining provisions shall remain in effect to the extent permitted by law.

Nothing in this agreement eliminates statutory protections, required cancellation rights, or legal remedies that cannot lawfully be waived.

SECTION 13: ACKNOWLEDGMENT OF AGREEMENT

I acknowledge that I have read and understand the participation requirements, training risks, medical provisions, and applicable liability terms described in this agreement.

I understand that participation is voluntary and that compliance with academy safety rules is required.

I acknowledge that this agreement applies to authorized classes, supervised open mats, seminars, private lessons, and other approved Mojo Dojo MMA activities.

Member/Guardian Initials:

SECTION 14: AUTOMATIC PAYMENT AUTHORIZATION, MEMBERSHIP CANCELLATION & NO-REFUND POLICY

14.1 Membership and Billing Information

Member Name: {name}

Membership Plan:

Recurring Payment Amount ($):

Billing Frequency:

Scheduled Billing Date:

Membership Start Date:

Initial Commitment or Minimum Term (if applicable):

14.2 Authorization for Automatic Payments

By affirmatively accepting this payment authorization and signing below, I authorize Mojo Dojo MMA and its designated payment processor to automatically charge my authorized payment method for the recurring membership dues described above.

This authorization may apply to an approved credit card, debit card, or bank account, depending on the payment method I separately provide.

I understand that payments will be processed according to the disclosed amount and schedule and will continue until the authorization is revoked or the membership is properly canceled or terminated, subject to applicable law.

I authorize only the charges disclosed and agreed to. Additional purchases, fees, or materially different charges require appropriate authorization.

I understand that Mojo Dojo MMA does not need to request separate approval before each regularly scheduled, authorized payment.

Payment Authorization Initials:

14.3 Membership Cancellation — 14-Day Notice Requirement

I understand and agree that Mojo Dojo MMA requires at least fourteen (14) calendar days’ advance written notice before the next scheduled billing date for ordinary voluntary membership cancellation, except where applicable law provides different cancellation rights.

Cancellation requests must be submitted in writing through the member portal at {login_link} or delivered to Mojo Dojo MMA at:

2 Pennsylvania Ave, Matamoras, PA 18336.

For example, if my next scheduled payment is December 1, I must provide cancellation notice no later than November 17 to satisfy the 14-day advance-notice requirement.

If my cancellation notice is received fewer than 14 calendar days before the next billing date, my membership will ordinarily terminate after the upcoming billing cycle, provided this is consistent with applicable law and my membership terms.

Cancellation does not eliminate lawfully incurred charges or financial obligations.

I understand that statutory cancellation rights, where applicable, take precedence over this ordinary cancellation policy.

Cancellation Policy Initials:

14.4 No-Refund Policy

MOJO DOJO MMA MAINTAINS A NO-REFUND POLICY EXCEPT WHERE A REFUND IS REQUIRED BY APPLICABLE LAW.

Membership payments are generally nonrefundable once lawfully charged.

Mojo Dojo MMA does not ordinarily provide refunds or prorated credits for:

• Missed classes or voluntary absences.
• Unused training sessions or membership time.
• Personal scheduling conflicts.
• Vacations or voluntary breaks from training.
• A voluntary decision to discontinue training during an already-paid membership period.

I understand that canceling my membership does not automatically entitle me to a refund for a previously paid billing period.

This provision does not limit any statutory rights to cancellation or refunds, remedies for unauthorized or erroneous charges, or other protections required by applicable law.

No-Refund Policy Initials:

14.5 Failed or Declined Payments

I understand that I am responsible for keeping my authorized payment information current.

If a scheduled payment is declined, I agree to update my billing information and resolve any outstanding lawful balance.

Mojo Dojo MMA may temporarily restrict membership access for unpaid dues, consistent with the membership agreement and applicable law.

Any late fees or returned-payment fees must be separately disclosed and lawfully authorized.

Billing Responsibility Initials:

14.6 Revocation of Automatic Payment Authorization

I understand that I may revoke authorization for future automatic payments by notifying Mojo Dojo MMA.

For covered recurring bank-account transfers, I also understand that applicable federal law provides the right to issue a stop-payment instruction through my financial institution.

Revoking automatic payment authorization does not, by itself, cancel the underlying membership contract or eliminate lawfully incurred payment obligations.

Mojo Dojo MMA will not initiate further electronic debits after a revocation becomes effective, except as permitted by applicable law.

14.7 Payment and Cancellation Acknowledgment

I understand that:

• My membership may be billed automatically according to the agreed payment schedule.
• Ordinary voluntary cancellations require 14 calendar days’ written notice before the next billing date, subject to applicable legal rights.
• Membership payments are generally nonrefundable except where law requires otherwise.
• I am responsible for maintaining accurate billing information.
• I have the right to revoke recurring electronic payment authorization as provided by applicable law.

Member/Guardian Initials:

SECTION 15: OPTIONAL PHOTOGRAPHY AND VIDEO CONSENT

Mojo Dojo MMA may capture photographs or videos during classes, seminars, competitions, and academy events for social media, website content, advertising, and team recognition.

Photography permission is optional and is not required for participation in regular classes.

YES — I consent to Mojo Dojo MMA using identifiable photographs and recordings of me or my child for academy publicity, educational content, and marketing without compensation.

If this box is left unchecked, I do not grant photography or promotional video consent under this agreement.

I understand that I may withdraw consent for future publications by notifying the academy in writing. Withdrawal may not remove materials already distributed or shared by third parties.

Member/Guardian Initials:

SECTION 16: FINAL ACKNOWLEDGMENT AND ELECTRONIC SIGNATURE

PLEASE READ THIS AGREEMENT CAREFULLY BEFORE SIGNING.

By signing below, I certify and acknowledge that:

1. I have read and understand this complete membership agreement.
2. I understand the inherent risks associated with Brazilian Jiu-Jitsu and martial arts training.
3. I agree to follow Mojo Dojo MMA’s safety rules and code of conduct.
4. I understand the medical and emergency authorization provisions.
5. If I am an adult participant, I understand the ordinary-negligence release in Section 4.
6. If signing for a minor, I certify that I am authorized to consent to the minor’s participation.
7. I understand the membership cancellation and no-refund policies, subject to applicable law.
8. I have had an opportunity to ask questions before signing.
9. I voluntarily accept the terms of this agreement.

Membership Agreement Acceptance:

I acknowledge that I have read and agree to the applicable membership agreement, participation rules, and liability provisions.

Separate Automatic Payment Authorization:

I affirmatively authorize recurring automatic payments for the amount, frequency, and billing date disclosed in Section 14.

Participant Full Name: {name}

Participant Date of Birth: {dob}

Electronic Signature — Adult Participant or Parent/Legal Guardian:

Date Signed: {sign_date}

Final Initials:

MOJO DOJO MMA

2 Pennsylvania Ave, Matamoras, PA 18336

570-483-8130

www.mojodojomma.com

ONE TEAM. ONE FAMILY.

DISCIPLINE AND RESPECT.