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Waiver and Release of Liability

Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. These risks include, but are not limited to: falls which can result in serious injury or death, injury or death due to negligence on the part of myself, my training partner, or other people around me, injury or death due to improper use or failure of equipment. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or my partner(s).

 

I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while attending classes at CrossFit SAC. I, the undersigned acknowledge that I have no physical impairments or illnesses that will endanger myself or others. 

 

Release: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities available at CrossFit SAC, I, the undersigned hereby release CrossFit SAC, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. Further I hereby grant CrossFit SAC and their agents the right to use my likeness in the form of a photograph or video for any purposes deemed necessary by CrossFit SAC and their agents. 

 

This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect.

 

If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit SAC to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child . 

 

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by CrossFit SAC Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorneys fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless CrossFit SAC, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my negligent or intentional act or omission while participating in activities offered by CrossFit SAC.

 

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.

First Athlete's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

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

First Name*

Middle Name

Last Name*
Tenth Athlete's Date of Birth*
Athlete's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health History / Lifestyle Questionnaire

Height

Weight
Present Physical Condition - Select your level.
Have you spoken to your doctor about this or any other exercise plan?

If yes, what were her recommendations?
Are you taking Prescription Medications?

List any Medications you are currently taking.
Do you smoke?

How many per week?
Do you drink alcohol?

How many drinks per week?

How many hours do you regularly sleep a day?

When?
Describe your job.
Recent Surgery?
Heart Condition?
Breathing or Lung Problems?
Dizziness?
Muscle/Joint/Back Disorder?
Asthma?
Diabetes?
Hypertension?
Thyroid Condition?
Arthritis?
Hernia?
Osteoporosis?

Please describe any medical conditions checked above.
Your assessment of your current eating habits:
Do you have or have you had any eating disorder?

Describe

Recent/Current Injuries (Cause/Effect)

Past Athletic Activity (sports played, physical hobbies,Etc)

Current Workout/Activities
What is your experience with CrossFit?

Physical/Health Goals: Be specific Short Term (1 month) *

Medium Term Goals (3-6 months) *

Long Term Goals (1 year and more) *

Who's your favorite sports team?

What's your favorite movie?
Additional information about Minor Athletes
Allergies?*
No
Yes

If Yes, please describe

Is anyone else allowed to pick-up your child from class?

Is there anything we should know about your child?
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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

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.


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