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This waiver is required for all participants at CrossFit Potero Hill.

 

Participants involved in any activities offered by CrossFit Potrero Hill may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the CrossFit Potrero Hill website or in any editorial, promotional or advertising material produced and/or published by CrossFit Potrero Hill.

I Agree

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; strains and sprains. 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 at, or under direction of CrossFit Potrero Hill.I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.Physical Condition: I further acknowledge that I am in good physical condition and have no medical reasons, impairments, or disability that might prevent me from safely engaging in any or all CrossFit Potrero Hill activities. I acknowledge that no person, principal member, employee or volunteer of CrossFit Potrero Hill gave me medical advice before joining which might relate to my physical condition or ability to engage in any CrossFit Potrero Hill activities. I further acknowledge that should I have any health issues or medical concerns now or after joining, I should discuss them with a physician before engaging in any CrossFit Potrero Hill activities. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me 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 offered by CrossFit Potrero Hill, I, the undersigned hereby release CrossFit Potrero Hill, 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. 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 Potrero Hill 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 Potrero Hill. 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 Potrero Hill, 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 Potrero Hill, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by CrossFit Potrero Hill. I acknowledge and specifically intend that this release and waiver of rights shall be effective not only on the date hereof but also on all occasions subsequent hereto when I shall engage in any and all activities offered by CrossFit Potrero Hill. 

 

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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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*

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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