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Vertile Pty Ltd

ABN: 87 622 471 818

Participant Agreement, Release and Assumption of Risk

 

RELEASE AND WAIVER

In consideration of the services of Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf, I hereby agree to release, indemnify, and discharge Balanced, (Vertile Pty Ltd), on behalf of myself, my spouse, my children, my parents, my heirs, assigns, personal representative and estate as follows:

I acknowledge that high intensity exercise must be approached cautiously at the beginning, with a gradual increase in intensity in order to allow the muscles to adapt to the demands placed on them.  I acknowledge that failure to do so may place myself at risk of Rhabdomyolysis which causes muscle damage and seriously affects the internal organs.  I acknowledge that participating in CrossFit can cause Rhabdomyloysis.  Warning signs of Rhabdo include brown urine, complete muscle weakness and/or swelling of the joints, and if I develop these symptoms I will seek immediate medical assistance. 

I acknowledge and voluntarily accept that Balanced entails known and unanticipated risks that could result in physical or emotional injury, paralysis, death, or damage to myself, to property, or to third parties.  I understand that such risks simply cannot be eliminated without jeopardizing the essential qualities of the activity. 

I expressly agree and promise to accept and assume all the risks existing in the activities required and associated with Balanced.  My participation in Balanced is purely voluntary and I elect to participate in spite of the risks

I acknowledge and voluntarily accept that the risks include but are not limited to: 

the hazards of walking on uneven terrain and slips and falls;
lifting, carrying, throwing or moving with equipment;
the forces of nature, including but not limited to lighting and rapid weather changes;
the risk of exposure to insect bites;
the risk of cold including hypothermia;
my own physical condition and physical exertion associated with this activity.

I hereby voluntarily release, forever discharge and agree to indemnify and hold harmless Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf, from any and all claims, demands, or causes of action, which are in any way connected with my participation in this activity or my use of Balanceds (Vertiles) equipment or facilities, including any such claims which allege:

negligent acts or omissions of Balanced (Vertile Pty Ltd)
breach of duty in negligence;
breach of contract; and 
any breach of statutory duty.

Should Balanced (Vertile Pty Ltd) or anyone acting on their behalf, be required to incur legal fees and costs to enforce this agreement, I agree to indemnify and hold them harmless for all such fees and costs. 

I certify that I have adequate insurance to cover any injury or damage that I may cause or suffer while participating, or else I agree to bear the costs of such injury or damage to myself.  I further certify that I am willing to assume the risk of any medical or physical condition I may have. I also give Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf, permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expense incurred.

I understand that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions.  I understand that should I feel light-headed, nauseated, dizzy, faint, or experience pain or discomfort, I am to stop the activity and inform my Coach immediately.  

In the event that I file a lawsuit against Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf, I agree to do so solely in the State of QLD, and I further agree that the substantiative law of Queensland shall apply in that action.  I agree that if any portion of this agreement is found to be void or unenforceable, the remaining document shall remain in full force and effect.

I am fully aware of the risks involved with Balanced classes, and that I will not hold, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf, responsible for any injury or damage I may receive as a result of my voluntary involvement in such activities.

Use of picture(s)/film:  I agree to allow Balanced, (Vertile Pty Ltd), to use Picture(s) and/or film of me for advertising purposes.  In the event I choose not to allow the use of same for said purposes, I agree that I must inform Balanced of this in writing. 

I have had sufficient opportunity to read the 2 pages of this entire document.  I have read and understood it, and I agree to be bound by its terms.  Any questions I had were answered to my full satisfaction.

I further acknowledge and agree that due to the nature of the activity, it would be unreasonable for Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf to be in any way responsible for any injury to ME and I hereby, to the full extent permitted by law, waive all of MY legal rights of action against and fully release the BALANCED for loss, damages, injury or death howsoever arising out of or in relation to the participation by ME in the activities conducted or organised by the BALANCED including without limitation, liability for any negligent or tortious act or omission, breach of duty, breach of contract or breach of statutory duty on the part of Balanced, (Vertile Pty Ltd), their agents, owners, officers, volunteers, participants, employees, independent contractors and all other persons or entities acting in any capacity on their behalf.

I am aware that by signing this Release and Waiver form, I acknowledge that I am waiving certain level of rights (including the right to sue) against Balanced on the basis of any claim from which I have released them herein.

TERMS

- Suspension of memberships (ie putting payments on hold) are  on a case-by-case basis as discussed with Coaches. There are no holds over the Christmas / New Year period.

- Balanced reserves the right to refuse or cancel membership at any stage.

- Part payments are not accepted (including notice periods).

- There will be no refund of payments upon failure to give adequate notice of cancellation - refunds do not apply for outstanding memberships on cancellation - minimum 28 days notice is required to cancel or suspend a contract.

- There are a number of Public Holidays and periods throughout the year that Balanced will be closed. All holidays are factored into the fee structure.

- Monthly, 3 Month, 6 Month and 12 Month memberships will automatically renew (month-to-month) unless prior notification is received 28 days from expiry. 

 

First Members Name

First Name*

Last Name*

Phone*
First Members Date of Birth*
First Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
First Members Signature*
Second Members Name

First Name*

Last Name*
Second Members Date of Birth*
Second Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Third Members Name

First Name*

Last Name*
Third Members Date of Birth*
Third Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Fourth Members Name

First Name*

Last Name*
Fourth Members Date of Birth*
Fourth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Fifth Members Name

First Name*

Last Name*
Fifth Members Date of Birth*
Fifth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Sixth Members Name

First Name*

Last Name*
Sixth Members Date of Birth*
Sixth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Seventh Members Name

First Name*

Last Name*
Seventh Members Date of Birth*
Seventh Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Eighth Members Name

First Name*

Last Name*
Eighth Members Date of Birth*
Eighth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Ninth Members Name

First Name*

Last Name*
Ninth Members Date of Birth*
Ninth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Tenth Members Name

First Name*

Last Name*
Tenth Members Date of Birth*
Tenth Members Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
Parent or Guardian's Email Address

Email*

Confirm Email*
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*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
How did you find out about CrossFit 4000
Facebook
Instagram
Google
CrossFit Affiliate Finder
Friend Referral
Other

Do you have any injuries/conditions that we should be made aware of (if so please speak to your trainer immediately). Please provide details. *
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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