Loading...

BRAZEN FITNESS

PATRON WAIVER AND RELEASE OF LIABILITY

I, the undersigned, intend to use some or all of the activities, facilities, programs and services offered at or by BRAZEN FITNESS and CC CF, LLC. I understand that each person (myself included) has a different capacity for participating in such activities, facilities, programs and services. I am aware that many activities, facilities, programs and services offered are either recreational or self-directed in nature. I agree that my participation in any and all of the activities, facilities, programs and services provided at or by BRAZEN FITNESS is strictly voluntary. I further agree that my participation in any and all activities, facilities, programs and services provided at or by BRAZEN FITNESS is at my own risk and that I assume any and all risk of injury, illness, death, damage or loss that might result. I also agree to assume all risk of damage, loss or theft to or of any of my personal property. 

I Agree

In consideration of being permitted to use some or all of the activities, facilities, programs and services offered at or by BRAZEN FITNESS and CC CF, LLC, I do hereby waive, release and forever discharge CC CF, LLC and its members, officers, employees, agents, representatives and all others acting on its behalf (collectively, the indemnified parties) from any and all claims or causes of action (known or unknown) for any and all injury, illness, death, damage or loss that may occur to me or my property as a result of my participation in any aspect of the activities, facilities, programs and services offered at or by BRAZEN FITNESS and CC CF, LLC. I acknowledge that the foregoing waiver and release includes, without limitation, claims or causes of action relating to or arising from my use of facilities, equipment or machinery in connection with the activities, facilities, programs and services offered at or by BRAZEN FITNESS and CC CF, LLC. I do hereby agree to indemnify, defend and hold harmless the indemnified parties from any and all liabilities, expenses and claims made as a result of my participation in such activities, facilities, programs and services, whether caused by negligence or otherwise. In consideration of my use of the facilities, activities, programs and services offered at or by BRAZEN FITNESS and CC CF LLC, I hereby take these actions on behalf of myself, my executors, administrators, heirs, next of kin, successors, and assigns. I further understand that at BRAZEN FITNESS, I may be photographed or filmed, and I hereby agree to allow my photo, video, or film likeness to be used for any legitimate business purpose by CC CF, LLC and its assigns.

I declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation in any of the activities, facilities, programs and services offered at or by BRAZEN FITNESS. I acknowledge that I have either had a physical examination and have been given a physicians permission to participate in these activities, facilities, programs and services, or that I have decided to participate in these activities, facilities, programs and services without the approval of my physician. 

I understand that the activities, facilities, programs and services offered by BRAZEN FITNESS may sometimes be conducted by persons who may not necessarily be knowledgeable, licensed, certified or registered instructors or professionals. I accept the fact that the skills and competencies of some CC CF, LLC employees, agents, representatives or volunteers will vary according to their training and experience and that no claim is made to offer assessment or treatment of any mental or physical disease or condition by those who are not duly licensed, certified or registered and employed to provide such professional services. 

I Agree

 

Rhabdomyolysis Release: 

Rhabdomyolysis (hereinafter referred to as "Rhabdo") can occur when an individual's physical activity is so intense that muscular cells begin to breakdown and the contents and/or remaining materials enter the bloodstream. Rhabdo may be caused by many other systemic or environmental causes. However, Exertional Rhabdo can occur in athletes of all levels of fitness, resulting in muscle cell destruction. The skeletal muscle breakdown impairs kidney function as those organs are unable to handle increased enzymes that are released into the bloodstream. This induces severe physiological changes in the body. The symptoms of Rhabdo include muscle pain, stiffness and extreme weakness, darkening of the urine (similar to the color of tea or cola), decreased urine output, altered mental status, swelling of the body part involved, either with or without pain. A Rhabdo symptom is pain out of proportion to the amount of soreness that one would generally expect, often producing pain much quicker than one would expect after a workout.

 

I, the undersigned, understand that any concerns on my part that I am experiencing any of the symptoms of Rhabdo require immediate presentation to a hospital for emergency treatment. I acknowledge that no third party, either from the facility or otherwise, will be capable of monitoring my urine output or color, and it is my responsibility to be continually cognizant of this symptom and all other symptoms and to monitor them in my own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of Rhabdo. I understand that statistically individuals most likely to experience Rhabdo are those who are in good shape by general standards or who were previously in good physical shape. This includes individuals who were prior athletes. I acknowledge that often the more mentally tough an athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo.

I, the undersigned, agree to monitor myself in a manner that is proportionate to the potential injury that can be occasioned by this condition. I acknowledge and understand that I am the only individual capable of determining if I am experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose myself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding physical activity. I for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors.

I Agree

 

Coronavirus/COVID-19 Release

The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. 

CC CF, LLC doing business as BRAZEN FITNESS has put in place preventative measures to reduce the spread of COVID-19; however, BRAZEN FITNESS cannot guarantee that clients or their child(ren) will not become infected with COVID-19. Further, attending BRAZEN FITNESS could increase the risk of contracting COVID-19. 

By attending events and/or entering the facilities at BRAZEN FITNESS, I certify that I have not had a COVID-19 diagnosis, have not been out of the United States in the past fourteen (14) days leading up to the event or my visit to BRAZEN FITNESS, and that, to my knowledge, I have not been exposed to a confirmed case of COVID-19 in the past fourteen (14) days leading up to the event or my visit to BRAZEN FITNESS. I also certify that I am not experiencing any the primary symptoms of COVID-19 at the time of the event or of my entering the facilities at BRAZEN FITNESS.

I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND CONSTITUTES A CONTRACT BETWEEN ME AND CC CF, LLC “BRAZEN FITNESS”.

 I SIGN THIS AGREEMENT FREELY AND VOLUNTARILY WITHOUT DURESS OR COERCION AND I AM AND HAVE BEEN FULLY INFORMED OF THE CONSEQUENCES OF MY SIGNATURE HERETO.

I Agree

 

I, the undersigned, am a voluntary participant in all activities attended by me which place at BRAZEN FITNESS’s gym, 607 S Ball St, Arlington, VA 22202, or other activities attended at alternate locations in association with BRAZEN FITNESS.  

I AM AWARE THAT ATTENDANCE AT BRAZEN FITNESS’S GYM MAY INVOLVE INTERACTION THAT COULD POTENTIALLY LEAD TO INJURY, SICKNESS OR EVEN DEATH. I AM VOLUNTARILY PARTICIPATING IN THESE ACTIVITIES AND INTERACTIONS WITH KNOWLEDGE OF THE DANGER INVOLVED AND AGREE TO ASSUME ANY AND ALL RISKS OF BODILY INJURY, DEATH, PROPERTY DAMAGE, OR OTHER LOSS, WHETHER THOSE RISKS ARE KNOWN OR UNKNOWN. I AM EXPRESSLY ASSUMING THE RISKS ASSOCIATED WITH MY PARTICIPATION IN THIS ACTIVITY. I AM EXPRESSLY ASSUMING THE RISKS ASSOCIATED WITH THE CURRENT COVID-19 PANDEMIC AND CONTINUE THIS ACTIVITY AGAINST CENTER FOR DISEASE CONTROL AND/OR GOVERNMENTAL DIRECTIVES.

I certify that I am fully capable of participating in this activity. Therefore, I assume and accept full responsibility for myself, including all minor children in my care, custody, and control, for bodily injury, death, or loss of personal property and expenses as a result of those inherent risks and dangers not specifically identified, and as a result of my negligence in participating in this activity. 

I hereby waive, release and forever discharge CC CF, LLC DBA BRAZEN FITNESS (“Released Parties”) from any and all claims I may have now or arising in the future related to my participation in events, classes, or solo exercise at BRAZEN FITNESS or in association with BRAZEN FITNESS. I covenant and agree not to sue any Released Parties for any such claims. I hereby waive, release and forever discharge the Released Parties from all of the following (the “Claims”): any and all claims, liabilities of every kind, demands, damages (including direct, indirect, incidental, special and/or consequential), losses (economic and non-economic), and causes of action, of any kind or nature, which I have or may have in the future (including court costs, attorneys’ fees and litigation expenses), that may arise out of, result from, or relate to my participation in the session or my travel to and from such activities. I understand and acknowledge that these Claims include, but are not limited to, causes of action for death, personal injury, partial or permanent disability, negligence, and property damage or theft; causes of action relating to the provision of first aid, medical care, medical treatment, or medical decisions; and claims for medical or hospital expenses, including medical transportation services. I understand and agree that the foregoing waiver, release and discharge applies even if the Claims are caused by the negligent acts, omissions, or carelessness of any Released Parties. I understand that this waiver, release and discharge operates for myself as well as on behalf of my spouse, children, parents, guardians, heirs, next of kin and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on my behalf. I further agree to indemnify and hold harmless all released parties from any claims which I might make or which might be made on my behalf by others or which might be made against me by others, arising from my participation in the activities provided by the released parties, my travel to or from such activities. 

 

This waiver shall remain valid unless expressly revoked by the participant or parent or guardian of a minor, in writing, with receipt acknowledged by the released parties.

 

I Agree

 


First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!