Electronic Funds Transfer Authorization:
Direct Payment via ACH is the transfer of funds from a consumer account for the purpose
of making a payment.
By completing and submitting this Electronic Funds Transfer agreement, I authorize Gracie Durham Inc to initiate a monthly debit entry to my account in order to pay my monthly membership fee.
I understand that the designated bank account will be debited monthly, on the second day of the month.
This authorization will remain in effect until Gracie Durham Inc has received a notification otherwise.
I understand and have had explained to me that the martial art known as “Gracie Jiu-Jitsu” is taught using precautions to
avoid any injuries. However, participation in the Gracie Jiu-Jitsu classes carries with it certain inherent risks that cannot
be eliminated regardless of the care taken to avoid injuries. The specific risks range from minor injuries such as scratches,
bruises, and sprains, to major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and
concussions, to catastrophic injuries including paralysis and death. Furthermore, I understand the practice of Gracie Jiu-
Jitsu presents a risk of skin infections, communicable diseases, bacteria(s) and viruses, including, but not limited to, the
I understand and have had explained to me that, along with the possibility of personal injury, injury to property is also
possible, such as, but not limited to, possible loss of wages and the ability to earn such wages. With full knowledge of the
aforementioned dangers, both to my person and to my property (current and future), and after having these dangers fully
explained to myself and/or to my legal guardian.
I nevertheless desire to participate in Gracie Jiu-Jitsu training and activities.
I hereby certify and declare that I will release and forever hold free and discharge from any liability Gracie Durham Inc. d.b.a. Gracie Durham, Gracie Global LLC, d.b.a. Gracie University, and each of their owners, agents, stockholders, directors, officers, employees and representatives of and from all claims, demands, rights and causes of action of any nature whatsoever which may have or which may hereafter accrue to me, arising from and by reason of any and all bodily or personal injury, damage to property or other
loss and any consequence thereof, whether known or unknown, seen or unforeseen, resulting from my participation in
Gracie Jiu-Jitsu, their persons and entities mentioned above, including and not limited to any negligence on the part of
Gracie University, their owners, agents stockholders, directors, officers, employees, volunteers representatives.
Further, knowing and understanding these risks, nevertheless I hereby agree to voluntarily assume these risks and to release and hold harmless all the persons or entities mentioned above whom might otherwise be liable to me for damages. It is further understood that this waiver, release and assumption of risk is forever binding on my heirs and assigns. I also understand and acknowledge that I have and will maintain appropriate medical insurance during classes/training.
I understand that Gracie University crosschecks all of its students with the national sex offender database (NSOPW.gov)
for the safety of its students. I understand that Gracie University reserves the right to refuse service to any individual who
has been convicted of a sex crime.
I am also aware that for purposes of safety, security and quality control there are surveillance cameras mounted
throughout Gracie University. Furthermore, I understand and acknowledge that often times video recording or
photographs may be taken of me during classes/training. I hereby grant Gracie Global LLC, d.b.a. Gracie University the
unlimited use of my likeness in any format photo, video, or other, for promotional advertisement or commercial use in any
format known or yet to be developed in perpetuity, and I forfeit any form of payment. It is further understood that I will
not video record or photograph any classes/training without prior permission from Gracie University.
My digital checkbox on this document is evidence that I know and understand and have had this document explained to me, that I
fully understand the dangers that are inherent in this martial art and that I voluntarily certify that I will not hold Gracie Durham Inc. d.b.a Gracie Durham, Gracie Global LLC, d.b.a. Gracie University, Rener Gracie, Ryron Gracie, the Gracie family, their owners, agents, staff, volunteers, and/or assigns, responsible for any injury whether as a result of training or not, including, but not limited to,
any loss of personal property.