IMPORTANT: The following must be read and signature typed by Parent/Guardian. I/We the parents (guardians) of the above named child/ren, do hereby authorize my/our child to travel with East LA Jiu Jitsu, and as agents for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under general or special supervision of, any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of a licensed hospital, whether such diagnosis or treatment is rendered at office of said physician or at said hospital.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care rendered but it is given to provide authority and power on the part of the aforesaid agents to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his best judgement may deem advisable. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of the State of California.This health history is correct so far as I know, and the herein described has permission to engage in all prescribed activities except as noted by me and or my physician. I hereby give permission to the physician selected by the group director (or his/her representative) to order X-Rays, routine test, and treatment for the health for my child and to order injection and/or anesthesia and/or surgery for my child named above. This authorization shall remain effective through the extent of the scheduled program with East LA Jiu Jitsu, unless sooner revoked in writing and delivered to said agent. I further agree that East LA Jiu Jitsu, its Board of Directors, officers and staff, are hereby relieved of all liability in the event of an accident or injury to said minor. I/We, the undersigned, am/are aware that events scheduled by East LA Jiu Jitsu, and /or its organizers contain inherent risks and dangers which are out of control of East LA Jiu Jitsu,. I have and do hereby assume all the risks and will hold East LA Jiu Jitsu, and its affiliates, workers and employees harmless from any liability, actions suits, legal or otherwise. 

Under no circumstances will East LA Jiu Jitsu, and/or its organizers be held responsible for :
1. Equipment damage, loss or wear. 
2. Personal injury, property damage or any loss resulting from so called "Acts of God", acts of public enemies, arrest or restraint of any government, seizure under legal process, quarantines, restrictions, riots, civil commotions, strikes, war hazards or terrorists attacks.
3. Illness, death, accidents or injury resulting from freestyle/ramp skating. skateboarding, snowboarding, snow-play of any kind, and any other recreation East LA Jiu Jitsu, for the benefit of our activity. 
4. Loss of personal property, possessions or monies.
5. Any act of neglect of any person or company whose services are retained by East LA Jiu Jitsu, for the benefit of our activity. 
6. Any deviation, delay or curtailment of any kind which is beyond the control of East LA Jiu Jitsu. 
7. Additional expenses, if incurred under any of the above circumstances are the responsibility of the applicant (named above). I hereby also acknowledge the fact that East LA Jiu Jitsu, and any of its workers and/or employees have the right to terminate my participation in the activity at any time, because of health, unwarranted conduct or any other reason they deem harmful or detrimental to the group as a whole. By typing my name, I give full consent and stand in agreement with the above statement of medical and liability release. Parent/Guardian Signatures and Date