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INFORMED CONSENT/ASSUMPTION OF RISK

I agree to participate in one or more physical fitness program(s)/class(es) sponsored by Moa Fitness Inc. which may include, but not necessarily be limited to,  CrossFit Training, and/or training of any kind by any affiliate, subsidiary or partnership of Moa Fitness Inc.  Moa Fitness Inc. made me fully aware that the fitness programs/classes which Moa Fitness Inc. 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 programs/classes 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 or failure of equipment, or injury or death due to a medical condition, whether known or unknown by me.  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 any and all risks that I am exposing myself to as a result of my participation in Moa Fitness Inc. programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program.  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 Moa Fitness Inc. Moa Fitness Inc. informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. Moa Fitness Inc. informed me that these changes could include abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same.  With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Moa Fitness Inc. fitness programs/classes. 

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 Moa Fitness Inc., and with my full understanding of all of the above, I hereby waive, release, remise and discharge Moa Fitness Inc. 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 Moa Fitness Inc. fitness programs/classes, 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 Moa Fitness Inc. 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: I recognize that there is risk involved in the types of activities offered by Moa Fitness Inc. Therefore I accept financial responsibility for any injury that I or 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 Moa Fitness Inc., 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 Moa Fitness Inc.              

Use of picture(s)/film/likeness:  I agree to allow Moa Fitness Inc., 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 Moa Fitness Inc. of this in writing.

I have fully read and fully understand 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.

I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. 
I further acknowledge that MOA Fitness Inc. has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19.
I further acknowledge that MOA Fitness Inc. cannot guarantee that I will not become infected with the Coronavirus/Covid-19. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 may result from the actions, omissions, or negligence of myself and others, including, but not limited to, staff, and other clients and their families.


I voluntarily seek services provided by MOA Fitness Inc. and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending MOA Fitness Inc.

I attest that:
* I am not experiencing any symptom of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell.
* I have not traveled internationally within the last 14 days.
* I have not traveled to a highly impacted area within the United States of America in the last 14 days.
* I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. 
* I have not been diagnosed with Coronavirus/Covid-19 by state or local public health authorities.
* I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19.


I hereby release and agree to hold MOA Fitness Inc. harmless from, and waive on behalf of myself, my heirs, and any personal representatives any and all causes of action, claims, demands, damages, costs, expenses and compensation for damage or loss to myself and/or property that may be caused by any act, or failure to act of MOA Fitness Inc; or that may otherwise arise in any way in connection with any services received from MOA Fitness Inc. I understand that this release discharges MOA Fitness Inc. from any liability or claim that I, my heirs, or any personal representatives may have against MOA Fitness Inc. with respect to any bodily injury, illness, death, medical treatment, or property damage that may arise from, or in connection to, any services received from MOA Fitness Inc. This liability waiver and release extends to MOA Fitness Inc. together with all owners, partners, and employees.

 

First Athletes Name

First Name*

Last Name*

Phone*
First Athletes Date of Birth*
First Athletes Signature*
Second Athletes Name

First Name*

Last Name*
Second Athletes Date of Birth*
Second Athletes Signature*
Third Athletes Name

First Name*

Last Name*
Third Athletes Date of Birth*
Third Athletes Signature*
Fourth Athletes Name

First Name*

Last Name*
Fourth Athletes Date of Birth*
Fourth Athletes Signature*
Fifth Athletes Name

First Name*

Last Name*
Fifth Athletes Date of Birth*
Fifth Athletes Signature*
Sixth Athletes Name

First Name*

Last Name*
Sixth Athletes Date of Birth*
Sixth Athletes Signature*
Seventh Athletes Name

First Name*

Last Name*
Seventh Athletes Date of Birth*
Seventh Athletes Signature*
Eighth Athletes Name

First Name*

Last Name*
Eighth Athletes Date of Birth*
Eighth Athletes Signature*
Ninth Athletes Name

First Name*

Last Name*
Ninth Athletes Date of Birth*
Ninth Athletes Signature*
Tenth Athletes Name

First Name*

Last Name*
Tenth Athletes Date of Birth*
Tenth Athletes Signature*
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*
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 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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