Loading...

220 East Cota St. Santa Barbara, CA 93101 | (805) 845-4171

ACKNOWLEDGEMENT AND ACCEPTANCE OF RISK

I acknowledge that I have chosen to participate in one or more physical fitness program(s)/class(es) provided by Gravitas Fitness. which may include, but not limited to CrossFit group classes, individual training and/or coaching of any kind (hereinafter CrossFit Pacific Coast offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I, the undersigned, recognize and understand that the Gravitas Fitness Programs offered at Gravitas Fitness are not without varying degrees of risk which may include, but are not limited to the following: Injury to the musculoskeletal and/or cardio respiratory systems 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 of failure of equipment; or injury or death due to a medical condition, wheter known or unknown by me. I am aware that any of these aboce mentioned risks might result in serious injury or death to myself or my training partner(s).

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Gravitas Fitness Programs and accept full responsibility for any injury or death that may result from my participation in any Gravitas Fitness Programs. I herby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by Gravitas Fitness. I fully understand that there exists the possibility of adverse physical changes during an exercise program, that may include, but are not limited to, abnormal blood pressure, fainting, disorder of heart rhythm, stroke, rhabdomyelisis or extreme muscle damage, and in very rare instances, heart attack or even death. I also fully understand that the Gravitas Fitness Programs occur outdoors in a public space and, as such, I fully understand that I may encounter unexpected hazards and situations, including but not limited to, interactions with traffic, interactions with glass or other hazards on the ground, and interactions with people and/or pets. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Gravitas Fitness Programs.

Release:

In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities made available by Gravitas Fitness, and with my full understanding of all of the above, I voluntarily waive, release, discharge, and hold harmless Gravitas Fitness and its agents, officers, principals and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in Gravitas Fitness fitness programs/classes, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. In signing this document, I fully recognize and understand that if I (or any minor on whose behalf I am signing this release) am hurt, die, or my property is damaged, I am giving up my right to make a claim or file a lawsuit against CrossFit Pacific Coast, even if they if they negligently or by some other act or omission cause the injury or damage. 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.

Indemnification: I recognize that there is risk involved in Gravitas Fitness Programs. Therefore, I accept financial responsibility for any injury that I cause either to myself or to any other participant due to my own negligence. Should Gravitas Fitness, or anyone acting on their behalf, be required to incur attorney?s fees and defense costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify, defend, and hold harmless Gravitas Fitness, 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 Gravitas Fitness.

Use of picture(s)/film/likeness: I further agree to allow Gravitas Fitness, its agents, officers, principals, employees and volunteers the a picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Gravitas Fitness of this in writing.

July 19, 2018

I have read this document in its entirety. I fully understand the foregoing assumption of risk and release of liability and I understand that by signing it I have released any and all claims against Gravitas Fitness. I understand that this agreement 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 voluntarily tying or signing this form I am waiving valuable legal rights.

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*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Participant'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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.

Agree To This Document



Powered by  Smartwaiver