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CrossFit Oakdale

Release of Liability Waiver 

Informed Consent & Assumption of Risk

I 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 a risk of certain abnormal changes occurring during and/or following exercise which may include abnormalities of blood pressor 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 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 Sierra Athletics, LLC, DBA CrossFit Oakdale 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 negligence on the part of myself, 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 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 Sierra Athletics, LLC, DBA CrossFit Oakdale 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 Sierra Athletics, LLC, DBA CrossFit Oakdale. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Sierra Athletics, LLC, DBA CrossFit Oakdale 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, stroke or death. By signing this document, I assume all risks for my health and well-being and hold Sierra Athletics, LLC, DBA CrossFit Oakdale, as well as its  owners, employees, or other authorized agents, including independent contractors harmless there from. I understand that questions about exercise procedure and recommendations are encouraged and welcome.

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 and or health in any way. I waive claims, demands, causes of action or any claims that I may have for injuries or other damages arising out of participation in Sierra Athletics, LLC, DBA CrossFit Oakdale activities, including but not limited to the personal training/nutritional programs and programs/classes.

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Photo and Video Release:

I hereby grant Sierra Athletics, LLC, DBA CrossFit Oakdale permission to use my photograph/video image in any and all publications for CrossFit or Sierra Athletics, LLC, DBA CrossFit Oakdale including website entries, without payment or any other consideration in perpetuity. I hereby authorize Sierra Athletics, LLC, DBA CrossFit Oakdale 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 the 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 Sierra Athletics, LLC, DBA CrossFit Oakdale from all claims, demands and causes of action which I, my heirs, representatives, executors, administration or any other persons acting on my behalf or on behalf of my estate which may have by reason of this authorization. 

Indemnification:

I recognize that there is a risk involved in the types of activities offered by Sierra Athletics, LLC, DBA CrossFit Oakdale. Therefore I accept financial responsibility for any injury that I may cause either to 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 Sierra Athletics, LLC, DBA CrossFit Oakdale, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result in negligent or intentional acts or omission while participating in activities offered by Sierra Athletics, LLC, DBA CrossFit Oakdale. 

Rhabdomyolysis ("Rhabdo")

Rhabdomyolisys (herinafter referred ti 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 and environmental causes. However, Exertional Thabdo 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, swellig 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 quicket than one would expect after a workout.

I understand that any concerns on my part that I am 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 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 own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding the possible symptoms of Rhabdo. I understand that statistically individuals most likely to experience Rhabdo are thos 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.

I agree to monitor myself 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 I am experienceing Rhabdo symptoms. I hereby agree and do willingly assume responsiblity for any risks that I expose myself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding physical activity. I for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE AND CEVENANT NOT TO SUE SIERRA ATHLETICS LLC, dba CROSSFIT OAKDALE and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors.

I have fully read and fully understand the foregoing assumption of risk, and release 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 intention 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.

 

 

 

First Athlete's Name

First Name*

Middle Name

Last Name*

Phone*
First Athlete's Date of Birth*
First Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
First Athlete's Signature*
Second Athlete's Name

First Name*

Middle Name

Last Name*
Second Athlete's Date of Birth*
Second Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Third Athlete's Name

First Name*

Middle Name

Last Name*
Third Athlete's Date of Birth*
Third Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Fourth Athlete's Name

First Name*

Middle Name

Last Name*
Fourth Athlete's Date of Birth*
Fourth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Fifth Athlete's Name

First Name*

Middle Name

Last Name*
Fifth Athlete's Date of Birth*
Fifth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Sixth Athlete's Name

First Name*

Middle Name

Last Name*
Sixth Athlete's Date of Birth*
Sixth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Seventh Athlete's Name

First Name*

Middle Name

Last Name*
Seventh Athlete's Date of Birth*
Seventh Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Eighth Athlete's Name

First Name*

Middle Name

Last Name*
Eighth Athlete's Date of Birth*
Eighth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Ninth Athlete's Name

First Name*

Middle Name

Last Name*
Ninth Athlete's Date of Birth*
Ninth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Tenth Athlete's Name

First Name*

Middle Name

Last Name*
Tenth Athlete's Date of Birth*
Tenth Athlete's Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
Athlete'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*
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 Information
Do you smoke?*
No
Yes
Drink alcohol?*
No
Yes
What is your current level of fitness activity?*
None
1-2 times a week
3-5 times a week
6+ days a week

Back, Knee or Shoulder Pain? If so, please explain.

Prescription Medications?

Any other health conditions not listed?
Click to customize checkboxes
High Blood Pressure
Asthma
Diabetes
Heart Condition
Pregnant
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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