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TNEindustries L.L.C dba CrossFit Evoke

Release of Liability Waiver

Waiver and Release of Liability

Culture: In signing TNEindustires L.L.C dba CrossFit Evokes Waiver and Release of Liability, I,

the undersigned, am aware of the culture associated with TNEindustries L.L.C dba CrossFit Evoke. I understand that developing high levels of fitness involves hard work, dedication, and hopefully fun. The results of this can lead to extreme soreness, blood, sweat, tears, and other bodily fluids. In achieving results, there will be loud, offensive music and language. Coaches will use physical and verbal cues in teaching movements. I understand that physical contact between coaches and students alike is done in a professional manner and is essential for learning and developing camardarie. TNEindustries L.L.C dba CrossFit Evokes goal is to facilitate living life to its fullest by means of the highest levels of fitness desired by its participants. I, the undersigned, realize that it is my responsibility to manage my path to elite fitness by communicating with my coaches and pushing myself only to the levels within my comfort zone. It is TNEindustries L.L.C dba CrossFit Evokes responsibility to ask for levels slightly past that!
I Agree

Informed Consent / Assumption of Risk:

I,

the undersigned, am aware that there are significant risks involved in all aspects of physical training. I understand that the reaction of the heart, lungs, and vascular system to exercise cannot always be predicted with accuracy. I understand that there is risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart rate; chest, arm or leg discomfort; transient light-headedness or fainting; and in rare instances, heart attack, stroke or even death. Excessive work can result (in rare cases) in exertional rhabdomyolosis. I should look for signs of excessive soreness, darkened urine, and pain in the kidney areas in the days of the following a particularly intense workout. While this type of injury is relatively rare, it can occur due to a number of factors, including (but not limited to) genetic predisposition or dehydration that may be beyond the control of my trainer. I understand that the programs and classes offered by (TNEindustries L.L.C dba CrossFit Evoke from here on out) are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. These risks include, but are not limited to: falls which can result in serious injury or death, injury or death due to improper use or failure 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 can/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 TNEindustries L.L.C dba CrossFit Evokes 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 hereby 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 TNEindustries L.L.C dba CrossFit Evoke. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in TNEindustries L.L.C dba CrossFit Evokes programs/classes.

By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive, physical exercise. By signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including, but not limited to, abnormal blood pressure, rhabdomyolosis, fainting, heart attack , or death. By signing this document, I assume all risk for my health and well being and hold TNEindustries L.L.C dba CrossFit Evoke, as well as its owners, employees, and other authorized agents including independent contractors, harmless there from. I understand that questions about exercise procedure and recommendations are encouraged and welcome.

I Agree

Waiver and Release:

I fully understand that my personal exercise program may be strenuous and I choose to participate voluntarily. I accept all responsibility for my health and any results, injury or mishaps that may affect my well-being or health in any way. I waive any claims, demands, causes of action or any claims for relief whatsoever against, and release TNEindustries L.L.C dba CrossFit Evoke (as well as any of its owners, employees, or other authorized agents,

including independent contractors) from any and all liability claims and/or causes of action that I may have for injuries or other damages, arising out of participation in TNEindustries L.L.C dba CrossFit Evokes activities, including, but not limited to personal training / nutritional programs and or programs/classes.

I Agree

Photo/Video Release: I hereby grant TNEindustries L.L.C dba CrossFit Evoke permission to use my photograph/video image in any and all publications for CrossFit or TNEindustries L.L.C dba CrossFit Evoke, including web site entries, without payment or any other consideration in perpetuity. I hereby authorize TNEindustries L.L.C dba CrossFit Evoke to edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge TNEindustries L.L.C dba CrossFit Evoke from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have reason of this authorization.

I Agree

Child Care: In case that I choose to utilize TNEindustries L.L.C dba CrossFit Evokes childcare program, I give permission to have my child/children participate in games, play, and other age appropriate activities. TNEindustries L.L.C dba CrossFit Evokes staff has the permission to take my child/children to bathroom or change diapers as needed. I understand that my child/children will be in company of other children and I will not hold TNEindustries L.L.C dba CrossFit Evoke or their staff responsible for any damage(s)/injuries done to my child/children at the hand of other minors or my childs/childrens own activities. I understand that Im solely responsible for signing my child/children into childcare and picking them up at said time. I also give full permission for any person connected with Tneindustries L.L.C. dba CrossFit Evoke, 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.  

I Agree

Dog Run: In the case that I choose to utilize TNEindustries L.L.C dba CrossFit Evokes dog run, I understand that I do so at my own risk. TNEindustries L.L.C dba CrossFit Evoke are not responsible for any damages or injuries to any pet on premises.

I Agree

Indemnification: I recognize that there is risk involved in the types of activities offered by TNEindustries L.L.C dba CrossFit Evoke. Therefore I accept financial responsibility for any injury or injuries that I may cause either on myself 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 TNEindustries L.L.C dba CrossFit Evoke, 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 TNEindustries L.L.C dba CrossFit Evoke.

I Agree

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(s) and damge 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 have carefully read this Agreement and fully understand its contents. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, and of my own free will.

 

May 24, 2019

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How did you Hear about us? If referred, or by other option, please state who or where.*
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Who referred you, or where did you hear about us?
Physical Activity Readiness Questionnaire

If you answer yes, to any of the questions asked in the Physical Activity Readiness Questionnaire, you must provide a doctor's note clearing you to CrossFit activities, prior to taking any classes, or personal training sessions offered by Tneindustries L.L.C dba CrossFit Evoke.

1. Has your doctor ever said that you have a heart condition, and that you should only do physical activity recommended by a doctor? If yes, please explain.

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No
Yes

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2. Do you feel pain in your chest, when you do physical activity? If yes, Please explain.

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No
Yes

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3. In the past month, have you had chest pain, when you were not doing physical activity? If yes, please explain.

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No
Yes

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4. Do you loose balance, because of dizziness, or do you ever lose consciousness? If yes, please explain.

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No
Yes

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5. Do you have a bone or joint problem(i.e. neck, shoulder, back, knee, or hip) that could be made worse by change in your physical activity, not recommended by your doctor? If yes, please explain.

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No
Yes

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6. Is your doctor currently prescribing medication (i.e. water pills) for your blood pressure, cholesterol, or heart condition, and your doctor does not recommend physical activity because of the medication? If yes, please explain.

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No
Yes

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7. Do you know of any other reasons, why you should not do physical activity? If yes, please explain.

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No
Yes

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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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