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2345 E Michigan St, Suite 6, Orlando, FL 32806

PARTICIPANT WAIVER, RELEASE OF LIABILITY & ASSUMPTION OF RISK

Provider: LARUE LLC, doing business as Breakaway Martial Arts ("Breakaway"). Version: October 6, 2026.

1. ACTIVITIES AND SCOPE

I voluntarily participate in Breakaway instruction and activities, including assessments, trial sessions, private and semi-private lessons, group classes, seminars, open training, and Breakaway-led off-site programs. Activities include boxing, kickboxing, Muay Thai, mixed martial arts, Brazilian Jiu-Jitsu, wrestling, grappling, self-defense, sparring and partner drills; strikes, clinches, throws, takedowns, sweeps and submissions; heavy bags, pads, mitts, shields, exercise bikes and other training equipment; and fitness, strength, mobility and conditioning. This agreement covers my participation from the date signed until superseded by a new signed waiver. Material changes to its terms require new assent.

2. SPECIFIC RISKS

Training involves contact, exertion, falls, collisions and unpredictable participant actions. Risks include bruises, cuts, skin infections and other communicable illnesses, sprains, strains, fractures, dislocations, dental and eye injuries, ligament and tendon damage, concussions and repeated head trauma, neck or spinal injury, nerve damage, cardiovascular events, loss of consciousness, paralysis, permanent disability and death. Risks may involve training surfaces, equipment, bag movement, submissions, choking techniques, partner size or experience differences, and my or others' conduct. Protective equipment, supervision and reasonable precautions cannot eliminate every risk. Self-defense instruction does not guarantee safety in a real confrontation.

3. VOLUNTARY ASSUMPTION OF RISK

I understand the activities and knowingly accept the inherent risks of the activities I choose. I may decline any drill or sparring and stop at any time. I will promptly tell the instructor if I feel unsafe, injured, ill, dizzy or unable to continue. For a minor, the parent/guardian acknowledges these risks and gives permission to participate, subject to the limited release in the Minor Participant section.

4. ADULT RELEASE OF ORDINARY NEGLIGENCE — AGE 18 AND OLDER ONLY

For myself, to the fullest extent permitted by Florida law, I release and discharge LARUE LLC, doing business as Breakaway Martial Arts and its owners, members, managers, employees, instructors, coaches, independent contractors, volunteers and agents, and the owners and landlords of premises used for Breakaway activities (the "Adult Released Parties"), from claims for personal injury, illness, property damage, disability or death arising from my participation in the activities described above or use of the training premises, INCLUDING CLAIMS CAUSED BY THE ORDINARY NEGLIGENCE OF AN ADULT RELEASED PARTY, whether alone or together with other causes. This includes ordinary negligence in instruction, supervision, equipment or premises maintenance. This release does not cover gross negligence, reckless or intentional misconduct, or any claim that cannot lawfully be waived. This adult release does not waive a minor's claims. The sole release of a minor's claims is stated in the Minor Participant section.

PARTICIPANT RESPONSIBILITIES & SIGNATURE

5. SAFETY AND CONDUCT

I will follow instructions and safety rules, respect taps and verbal stop signals immediately, use required protective equipment, use reasonable care with partners and equipment, and refrain from unsupervised sparring or techniques I have not been authorized to practice. I will report unsafe conditions, equipment defects and injuries promptly. I will not train while impaired by alcohol, drugs or medication that makes participation unsafe. Breakaway may stop or restrict participation for safety. Suspected concussion symptoms require stopping training and appropriate medical evaluation before return.

6. HEALTH AND FITNESS

I am responsible for assessing whether participation is appropriate and obtaining medical advice when needed. I will disclose to my instructor any relevant injury, limitation or condition affecting safe participation and any needed accommodations. I will not undertake activities beyond my abilities or against medical restrictions. Breakaway provides martial arts and fitness instruction, not medical diagnosis, treatment or physical therapy, including in programs for older adults or people with Parkinson's disease. I will follow hygiene rules and not participate with a known contagious illness, contagious skin condition or uncovered bleeding wound.

7. EMERGENCY ASSISTANCE

If an emergency occurs, I authorize staff to call 911, contact my emergency contact and provide reasonable first aid within their training. For a minor, the guardian authorizes staff to seek emergency assistance and contact the guardian. This clause does not appoint staff as a health care surrogate or override rights or consent requirements under law. I accept responsibility for medical and transportation charges for myself, or for my child to the extent legally applicable, except amounts another party is legally responsible to pay.

8. PERSONAL PROPERTY AND LIMITED ADULT INDEMNIFICATION

I am responsible for my belongings. Loss, theft or damage claims are subject to the applicable release and its exceptions. An adult signer agrees to indemnify the Adult Released Parties for third-party claims and reasonable expenses only to the extent caused by that adult's own intentional misconduct, reckless conduct or knowing violation of safety rules. This does not require indemnification for a Released Party's conduct or for a claim brought by or on behalf of a minor. No indemnification obligation is imposed on a minor.

9. GOVERNING LAW; SEVERABILITY; OTHER AGREEMENTS

Florida law governs. If a provision is unenforceable, the remaining provisions continue to the extent permitted by law. This waiver does not establish membership fees, automatic payments, cancellation or refund terms; those belong in a separate membership agreement. Any photo or video marketing permission is optional and must be obtained separately; signing this waiver alone does not grant it.

10. ELECTRONIC SIGNATURES AND ACKNOWLEDGMENT

I agree to sign this agreement electronically when using Gymdesk and intend my electronic signature to have the same effect as my handwritten signature. I may request a copy and ask Breakaway about a paper-signing option before signing. I HAVE READ AND UNDERSTAND THIS AGREEMENT, INCLUDING ITS RISKS AND APPLICABLE RELEASE. I HAVE HAD AN OPPORTUNITY TO ASK QUESTIONS AND SIGN VOLUNTARILY. I understand an adult release includes certain ordinary-negligence claims. For a minor, a parent/guardian must sign the separate section in the Minor Participant section; a minor's signature alone is insufficient.

Adult participant printed name: {name} 

Adult participant signature: __________________________ Date: ______________

For electronic signing, retain signer identity, signature and date with this document.

MINOR PARTICIPANT — PARENT/GUARDIAN CONSENT & LIMITED RELEASE

Minor name: ______________________________ Date of birth: ______________

Parent/Guardian name: _____________________ Relationship: ______________

Guardian phone / email: __________________________________________________

NOTICE TO THE MINOR CHILD’S PARENT/GUARDIAN

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE

AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY

DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF

LARUE LLC OPERATING AS BREAKAWAY MARTIAL ARTS AND ITS OWNERS, AFFILIATES,

EMPLOYEES OR AGENTS USES REASONABLE CARE IN PROVIDING

THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY

INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE

THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH

CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM YOU ARE GIVING UP YOUR CHILD’S RIGHT AND YOUR RIGHT TO RECOVER

FROM LARUE LLC OPERATING AS BREAKAWAY MARTIAL ARTS AND ITS OWNERS,

AFFILIATES, EMPLOYEES OR AGENTS IN A LAWSUIT FOR ANY

PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY

PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A

NATURAL PART OF THE ACTIVITY. YOU HAVE THE RIGHT TO REFUSE

TO SIGN THIS FORM, AND LARUE LLC OPERATING AS BREAKAWAY MARTIAL ARTS AND ITS

OWNERS, AFFILIATES, EMPLOYEES OR AGENTS HAS THE RIGHT TO

REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS

FORM.

I certify that I am this child's parent/guardian as defined by Florida Statutes section 744.301 and have authority to sign. I have read this entire agreement and consent to the child's participation. Under section 744.301(3), on behalf of my child I waive and release claims against LARUE LLC, doing business as Breakaway Martial Arts and its owners, affiliates, employees or agents only for personal injury, including death, or property damage resulting from inherent risks in the activities described in this agreement. Inherent risks are dangers or conditions, known or unknown, characteristic of, intrinsic to, or integral to the activity, which are not eliminated even with due care in a reasonably prudent manner. They include failure to warn of an inherent risk and negligent or intentional conduct of the child or another participant, excluding the provider and its owners, affiliates, employees or agents from the term participant. This section does not release claims arising from risks that are not inherent, provider negligence that creates non-inherent risks, gross negligence, reckless or intentional misconduct, or claims that cannot lawfully be waived. The adult release and indemnification do not expand this limited child release.

Parent/Guardian signature: __________________________ Date: ______________

Minor acknowledgment/signature (if able): __________________________________