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Santa Cruz County Fitness,LLC (Dba Crossfit West & Dba CrossFit Ready)Application & Waiver

 


This form is an important legal document. It explains the risks you are assuming by beginning an exercise program. It is critical that you read and understand it completely. After you have done so, please complete the form and sign in the spaces provided at the bottom.

Santa Cruz County Fitness, LLC recommends that you clear your participation in any exercise program with your physician.

INFORMED CONSENT/ASSUMPTION OF RISK
I agree to participate in one or more physical fitness program(s)/class(es) sponsored by or offered by Santa Cruz County Fitness, LLC . Santa Cruz County Fitness, LLC made me fully aware that the fitness programs/classes which Santa Cruz County Fitness, LLC 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 Agree

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Santa Cruz County Fitness, LLC 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 Santa Cruz County Fitness, LLC . Santa Cruz County Fitness, LLC  informed me that there exists the possibility of adverse physical changes during an exercise program, and I fully understand the same. Santa Cruz County Fitness, LLC 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 Santa Cruz County Fitness, LLC  fitness programs/classes. 

I Agree
  
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 Santa Cruz County Fitness, LLC , and with my full understanding of all of the above, I hereby waive, release, remise, and discharge Santa Cruz County Fitness, LLC 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 Santa Cruz County Fitness, LLC  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.
I Agree

If I am signing on behalf of a minor child, I also give full permission for any person connected with Santa Cruz County Fitness, LLC  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
   
Indemnification: I recognize that there is risk involved in the types of activities offered by Santa Cruz County Fitness, LLC . 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 Santa Cruz County Fitness, LLC , 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 Santa Cruz County Fitness, LLC .
I Agree
  
Use of picture(s)/film/likeness:  I agree to allow Santa Cruz County Fitness, LLC , 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 Santa Cruz County Fitness, LLC  of this in writing. 
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 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 Agree

July 20, 2018

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*

Phone*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*

Phone*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*

Phone*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*

Phone*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*

Phone*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*

Phone*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*

Phone*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*

Phone*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*

Phone*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email
A signed copy of this waiver will be sent to the email address you provide.
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*

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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