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Athlete Waiver Required for Participation at DRiV FiTNESS/CrossFit DF/CrossFit DF Palatka & The Yoga Box

Consent, Waiver, Release, Hold Harmless and Indemnity Agreement

I/We, the undersigned(s), for and in consideration of providing the above referenced Participant with the opportunity to participate in DRiV FiTNESS, DRiV KiDS, DRiV Teens, Conditioning, The Yoga Box,CrossFit DFand CrossFit DF Palatka programming and classes, do hereby unconditionally release, remise, acquit, discharge and waive any and all claims, from all, and all manner of actions, cause and causes of action, negligence, suits, demands, damages, and claims whatsoever, in law or in equity, which the undersigned(s), their guardian(s), personal representatives, successors, heirs or assigns ever had, now have, or hereinafter can, shall, or may have, against DRiV FiTNESS, CrossFit DFand CrossFit DF Palatka, Drive Gym, LLC, The Yoga Box, Academy of Rising Stars, Inc.(hereinafter collectively referred to as the Gym), as well as any entity or individual, coach, trainer, volunteer, employee, independent contractor or other person employed by or associated with any of the foregoing entities or programs.

I/We, the undersigned, also agree to indemnify and hold harmless the Gym from any and all claims for damages or other relief including, but not limited to, personal injury, death, property damage or any type of claim or damage (including, but not limited to attorneys fees and litigation expenses at trial and any appeal) resulting from or arising out of the undersigneds participation in or association with, DRiV FiTNESS, CrossFit DF and CrossFit DF Palatka, or The Yoga Box programming, training, classes or other events, and any damages that may be occasioned or suffered as a result of conditions of the property, equipment, or any other cause or conditional whatsoever.

The undersigned represent that the Participant is physically and mentally capable and prepared to participate in the activities offered, and that the undersigned all understand and accept the fact that sports including, but not limited to, aerobics, gymnastic, weight-lifting and fitness training involve inherent risk of injury or worse, which risks the undersigned understand and do hereby voluntarily and knowingly assume and hold the Gym harmless.

I/We, the undersigned, have read the provisions of this Consent, Waiver, Release, Hold Harmless and Indemnity Agreement and we either understand it, or have been given the opportunity to ask questions regarding it, so that we are fully informed and understand its contents prior to signing below. I/We understand that the terms of this Agreement are legally binding and that I/we effectively waive certain rights that I/we may have under applicable law.

If the Participant is under the age of majority or is otherwise unable to form the capacity to contract, then by signing below the Participants Parent or Legal Guardian do hereby consent to the Participants participation and bind themselves, as well as the Participant, to all of the terms of this Consent, Waiver, Release, Hold Harmless and Indemnity Agreement.

By signing, the undersigned does consent to grant the Gym the irrevocable license to use the participants likeness or photograph in advertisements and in other manners that may promote the Gyms business, in the exercise of the Gyms sole and ultimate discretion.

RHABDOMYOLYSIS (RHABDO)
RELEASE AND WAIVER

I do hereby acknowledge the significant risks associated with the physical training and programing at this facility. I acknowledge and attest to having fully and carefully read and reviewed this RELEASE AND WAIVER including all subparagraphs prior to engaging in any physical activity at this facility.

Rhabdomyolysis (hereinafter referred to as Rhabdo) can occur when an individuals 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.

I understand and have been advised that generally the pain that is referred to as 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 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 acknowledge and understand that all individuals engaged in demanding workouts are potentially exposing themselves to Rhabdo or other injuries/negative physical results. However, 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 and/or prior military personnel, law enforcement or firefighters. I acknowledge that often the more mentally tough a potential athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo.

I acknowledge and fully understand that statistically the chances of me developing Rhabdo are extremely slight, but I likewise appreciate the necessity that I be aware of the symptoms of this condition. I 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.

With the opportunity to fully inform myself about Rhabdo and the risks thereof, I knowingly and freely assume and accept all such risks both known and unknown. I assume full responsibility and all risks from my participation in any physical activity at the facility. 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 DriveGym LLC, DRiV FiTNESS, CrossFit DF, CrossFit DF Palatka and/or their officers, directors, representatives,partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors.

Electronic signatures are considered, for all intents and purposes, as originals.

By signing below on this date of July 18, 2018, I/We acknowledge and agree to the terms of this agreement.

First Athletes Name

First Name*

Last Name*

Phone*
First Athletes Date of Birth*
First Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
First Athletes Signature*
Second Athletes Name

First Name*

Last Name*
Second Athletes Date of Birth*
Second Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Third Athletes Name

First Name*

Last Name*
Third Athletes Date of Birth*
Third Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Fourth Athletes Name

First Name*

Last Name*
Fourth Athletes Date of Birth*
Fourth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Fifth Athletes Name

First Name*

Last Name*
Fifth Athletes Date of Birth*
Fifth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Sixth Athletes Name

First Name*

Last Name*
Sixth Athletes Date of Birth*
Sixth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Seventh Athletes Name

First Name*

Last Name*
Seventh Athletes Date of Birth*
Seventh Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Eighth Athletes Name

First Name*

Last Name*
Eighth Athletes Date of Birth*
Eighth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Ninth Athletes Name

First Name*

Last Name*
Ninth Athletes Date of Birth*
Ninth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Tenth Athletes Name

First Name*

Last Name*
Tenth Athletes Date of Birth*
Tenth Athletes PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
Athletes 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 exciting updates from DRiV via email!
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Experience
Do you have CrossFit experience?*
Yes, more than 1 year
Yes, less than 1 year
I tried it a few times
No
If yes, where did you workout*
at an affiliate
on my own
n/a
How did you find DRiV?*
Member Referral
Website
Social Media
CrossFit.com
Drive By
Other
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's PAR-Q
Has your doctor ever said that you have a heart condition AND that you should only do physical activity recommended by a doctor?*
Yes
No
Do you feel pain in your chest when you do physical activity?*
Yes
No
In the past month, have you had chest pain when you were not doing physical activity?*
Yes
No
Do you have a bone or joint problem (for example, back, knee or hip) that could be made worse by a change in your physical activity?*
Yes
No
Do you lose your balance because of dizziness or do you ever lose consciousness?*
Yes
No
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure or heart condition?*
Yes
No
Do you know of any other reason why you should not do physical activity?*
Yes
No
Did you answer YES to any of the preceding seven questions? If you answered YES to one or more of the preceding questions, you must talk with your doctor by phone or in person BEFORE you start becoming much more physically active or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. Talk with your doctor about the activities you want to participate in and follow his/her advice.*
Yes
No
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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