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EVERYONE can CrossFit. Everyone has potential. Discover yours at AKP CrossFit!

AKP CrossFit

WAIVER OF LIABILITY AGREEMENT

I, the Parent or Guardian undersigned below, have volunteered my minor child named below (hereinafter “Child”) to participate in AKP CrossFit   classes or programs of physical exercise now and in the future (together “the Class”). I understand that there is an inherent risk associated with any exercise program—including my Child’s voluntary participation in the Class—that may result in injury, even serious or disabling, or death, and that this risk is always present and cannot be entirely eliminated. I hereby voluntarily and expressly assume the risks inherent in my CHILD’S participation in the Class, including the risk of injury, accident, death, loss, cost or damage to my PERSON, MY child’s person, or my property.

In consideration of AKP CrossFit’s agreement to instruct, assist, and train my Child in the Class, I hereby agree to the following:

A. Release and Waiver of Liability.

1. By signing this Agreement, I hereby waive and release AKP CrossFit, its members, employees, trustees, contractors, volunteers, representatives, agents, and successors, and anyone else acting for or on its behalf, and the owner/lessor of the premises, or anyone using the AKP CrossFit premises whether related to the Class or not, from any and all liability present, past and in the future relating to or arising out of the Class. I hereby on behalf of myself, my Child, my spouse, heirs, assigns, executors, administrators, agents, successors, legal representatives or any others who may claim on my behalf, promise not to sue, and hereby forever irrevocably waive, release, remise and discharge AKP CrossFit from any and 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 Child’s participation in the Class or any other programs offered or sponsored by AKP CrossFit or attending AKP CrossFit related events, both on and off of the AKP CrossFit premises. This Release and Waiver applies to all claims, foreseen or unforeseen, including negligence and breach of statutory or other duty of care. I understand and agree that this Agreement and Release and Waiver is intended to be as broad and inclusive as permitted by law. This Release and Waiver includes, without limitation, injuries which may occur as a result of equipment that may malfunction or break; any slip or fall within premises; and ailments during and/or post Class instruction. I UNDERSTAND THAT I HAVE FORFEITED MY AND MY CHILD’S RIGHTS TO SUE AKP CrossFit, AND THAT THIS IS A RELEASE OF LIABILITY THAT IS VALID FOREVER. 

2. In agreeing to this Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon my Child’s behalf, that the use of AKP CrossFit, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by AKP CrossFit have inherent risks. These risks include, but are not limited to, any injury of damage resulting from: negligence of employees, volunteer assistants, independent contractors of AKP CrossFit; negligent misuse of the facility, climbing walls, or equipment of AKP CrossFit; falling off or impacting against the climbing walls, impact surface, floors, or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers, visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur.

B. Right of Publicity Release and License on Behalf of a Minor. I grant AKP CrossFit and its members, representatives, employees, affiliates, subsidiaries, licensees, successors and assigns (collectively referred to herein as “AKP CrossFit”), the right to take photographs of my Child and property of my Child in connection with its business.

1. I further irrevocably grant exclusive permission to AKP CrossFit to use, publish, copyright and reproduce, my Child’s name, likeness, identity, image, voice, personal story, oral or written statements, and/or appearance as such may be embodied in any pictures, photographs, video recordings, audiotapes, digital images, and the like, taken or made on behalf of AKP CrossFit (collectively referred to herein as the “Authorized Works”), for any purposes in connection with its business (including but not limited to purposes of publicity, illustration, web content, public relations, editorial, or other advertising or trade purposes), and without restriction as to frequency or duration. I agree that AKP CrossFit may use such Authorized Works with or without my Child’s name, and I grant AKP CrossFit the unrestricted right to use a fictitious name in connection with the Authorized Works.

2. I further irrevocably grant AKP CrossFit all right, title, and interest that my Child may have in any of the Authorized Works, including any negatives, original prints, or reproductions thereof. This permission includes but is not limited to the entire copyright in any Authorized Works and/or the right for AKP CrossFit to reproduce, modify, sell, transfer, distribute, and/or publicly display any Authorized Works.

3. I understand and acknowledge that, as a result of this Release, AKP CrossFit shall have the unrestricted right to any Authorized Works. I irrevocably release my Child’s rights of publicity, editorial rights, inspection rights, or any other rights with respect to the Authorized Works. I further irrevocably waive the right to receive any payment for signing this Release and/or for AKP CrossFit’s use, publication, reproduction or copyright of any of the Authorized Works. I hereby irrevocably release AKP CrossFit from any and all claims arising out of or relating to the Authorized Works. The permissions granted in this Release extend to all languages, media, formats and markets now known or hereafter devised, and are granted regardless.

4. If any provision of this Release or the application thereof to any person or circumstance shall be invalid, illegal or unenforceable to any extent, the remainder of this Release and the application thereof shall not be affected and shall be enforceable to the fullest extent permitted by law. This Release constitutes the entire agreement between the parties and supersedes all previous agreements on this matter. There are no other written or oral agreements, representations, or understandings with respect to the subject matter of this Release.

C. Indemnification. I agree to indemnify and hold harmless AKP CrossFit’s officers, directors, employees, authorized agents, to include independent contractors, or volunteer interns 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 my Child participates in activities offered by AKP CrossFit. I recognize that there is risk involved in the types of activities offered by AKP CrossFit. Therefore, I accept financial responsibility for any injury that I or my Child may cause either to myself, my Child, or to any other participant due to my or my Child’s negligence. Should AKP CrossFit, or anyone acting on its behalf, be required to incur attorney fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs.

D. Acknowledgement and Assumption of the Risk.

1. I am aware that specific risks to my Child vary within the Class and the risks range from minor injuries to major injuries, such as catastrophic injuries including death. I affirm that I alone am responsible for deciding whether to have my Child participate within the Class, and I understand that I am free to stop my Child from participating in the Class at any time.

2. I acknowledge that I take full responsibility for my life and well being, as well as the lives and well being of my Child and family, and all decisions made by me and my Child and family during and after the Class. I hereby expressly assume the risks of the Class, including the risk of injury, accident, death, loss, cost or damage to my person, my Child and my family, or my property.

3. I represent that my Child is in good health and has no disability, impairment, injury, disease, or ailment, preventing my Child from engaging in active or passive exercise or which could cause increased risk of injury or adverse health consequences as a result of exercise. I affirm that I have disclosed any and all physical limitations, disabilities, ailments, or impairments which may affect my Child’s ability to participate in the Class. I assume the responsibility to update AKP CrossFit of any changes in my Child’s medical condition now or in the future that might affect my Child’s safety or participation in the Class prior to the commencement of any such Class, and I understand that AKP CrossFit shall not be liable should I fail to do so. If my Child is pregnant or becomes pregnant or is post-natal, my signature verifies that my Child is participating in the Class with her doctor’s full approval.

4. I understand and acknowledge that AKP CrossFit does not manufacture fitness or other equipment at its facilities, but purchases and/or leases equipment. I also understand and acknowledge that AKP CrossFit is providing recreational services and shall not be held liable for defective products.

5. I understand that the AKP CrossFit does not diagnose illness, disease or any other mental or physical disorder, or prescribe medical treatment of pharmaceuticals. I understand and acknowledge that AKP CrossFit is providing non-medical services, and the Class is not a substitute for medical attention, diagnosis or treatment and that it is recommended that my Child see a medical practitioner for any physical ailment that my Child may have. I understand and agree that AKP CrossFit may not be held liable for my Child’s injuries sustained as a result of the Class or Instructor counseling provided to me.[initia]

E. Rules and Regulations. I agree that I, my Child, and my family and guests will abide by the rules, regulations and schedules of AKP CrossFit as stated herein, as well as those that may be posted at the facility, on the AKP CrossFit website, or issued orally, and which may be amended from time to time at AKP CrossFit’s sole discretion (together the “Rules and Regulations”).

F. Class Schedule. Class schedule is subject to change, and Class may be cancelled due to unexpected circumstances. AKP CrossFit reserves the right to change the Class schedule at any time, including the addition or the deletion of the Class, as well as changes in Instructors, Class times and length of the Class. AKP CrossFit also reserves the right to cancel Classes or modify hours of operation for repair, maintenance or special occasions. Attendance is based on a first-come, first-served policy.

G. Minor Children: I understand that I may bring another minor child or children to AKP CrossFit while my Child participates in Classes, but that I do so at my own risk and that of the other minor child or children. I understand AKP CrossFit accepts no responsibility for any damage, injury or loss that I or the other minor child or children may sustain while on the premises of the AKP CrossFit facility. I understand that AKP CrossFit does not offer child care of any sort and that no employee, agent, independent contractor or owner of AKP CrossFit will be watching my other minor child or children while my Child takes Class. My minor child or children and his/her/their actions are my responsibility while my Child participates in Class at AKP CrossFit.

H. Loss of Property. I understand and agree that AKP CrossFit will provide an area for my and my Child’s personal belongings to be held during the Class; however, I understand and agree that all such personal belongings are brought at my sole risk as to such property’s theft, damage, or loss. I am aware that neither I nor my Child should not bring valuables onto the premises of the AKP CrossFit facility, and I understand and agree that AKP CrossFit shall not be liable for the disappearance, loss, theft, or damage to my or my Child’s personal property, including but not limited to money, negotiable securities, items left in coat check lockers, or jewelry.

I. Emergencies. I hereby consent for my Child to receive first aid from AKP CrossFit in the event of an accident, injury or illness during the Class and I give AKP CrossFit permission to seek emergency medical services for my Child in those circumstances and agree that I am responsible for any expenses incurred. I hereby agree to hold harmless and indemnify AKP CrossFit from any and all Liability arising as a consequence of AKP CrossFit providing first aid/or seeking emergency medical services for my Child.

J. Rhabdo Notice.

1. I do hereby acknowledge the significant risks associated with the physical training and Rhabdomyolysis (hereinafter referred to as “Rhabdo”) can occur when an individual’s 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. 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.

2. I understand that any concerns on my part that my Child is 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 Child’s 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 Child at all times. I agree that I will remove my Child from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of Rhabdo in my Child.

3. 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. I acknowledge that often the more mentally tough an athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo.

4. I agree to monitor my Child 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 my Child is experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose my Child to and accept full responsibility for any injury or death that may result from my Child participating in this significantly demanding physical activity.

5. There is a wealth of medical and popular information regarding Rhabdo available on the Internet. AKP CrossFit strongly recommends that you review and evaluate information from all sources available to you, including your Child’s physician, prior to executing this Release and Waiver or having your Child participating in strenuous physical activity.

I ACKNOWLEDGE THAT I HAVE THOROUGHLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I voluntarily and knowingly agree to the terms and conditions stated herein. I recognize that BY SIGNING THIS DOCUMENT, I AM WAIVING CERTAIN LEGAL RIGHTS, INCLUDING ANY RIGHT I OR MY CHILD, OR MY OR MY CHILD’S heirs, next OF KIN, executors, administrators and assigns MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST AKP CrossFit. I intend for my signature to be a complete and unconditional release of liability OF AKP CrossFit to the greatest extent permitted by law.

I warrant that I am at least eighteen (18) years old. I hereby certify that I am the parent or guardian of my Child, who is under the age of eighteen (18) years, to whom this Agreement applies and that I have the legal authority to execute this Release.I have read this Agreement, understand its terms, and enter into it freely on behalf of my Child. I approve the foregoing and agree that we both shall be bound thereby.

 

First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Health Questions
Does your child take prescription medications?*
No
Yes

Does your child have any allergies?
Does your child currently participate in regular exercise or sports?*
No
Yes
How often does your child or practice exercise each week?*
1-2 times
3-4 times
5 or more times
None
Has your child had previous surgeries or injuries that would affect your participation?*
No
Yes

Any other health conditions you would like us to know about?
CrossFit Experience
Has your Child participated in CrossFit before?*
No
Yes

Where have you CrossFit?

How long have you been CrossFitting?
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

What Grade is your child currently in?

What school does your child attend?

What is your goal for your child in attending classes at AKP?

Does your child participate in a sport? If so, what sport?

What are your child's favorite activities?

Is there anything else you would like to be sure we know about your child?
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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