Loading...

 FULL AND COMPLETE RELEASE OF
 LIABILITY AND INDEMNITY AGREEMENT

TODAY'S DATE: December 10, 2019

I, the undersigned (or legal guardian of the undersigned) recognize that there are risks in any adventure sport or activity associated with CrossFit. I am fully aware of the possible risks and dangers inherent in participating in the sport of CrossFit, including, but not limited to, possible falls, spills, collisions with weight, ect. Accordingly, I understand that I must control my intensity/speed at all times, anticipate the unexpected and that I AM SOLEY RESPONSIBLE FOR MY OWN SAFETY. I also understand that the workouts can be difficult and challenging.

I acknowledge that CrossFit and related activities are EXTREMELY HAZARDOUS activities and that I have made a voluntary choice to participate in those activities despite the EXTREME risks that they present. In consideration of my being permitted to participate in CrossFit I agree to ASSUME ANY AND ALL RISK OF INJURY, DEATH, or RHABDOMYOLYSIS*, which might be associated with or result from my participation. I have also been informed that other possible adverse changes such as abnormal blood pressure, fainting, disorder of heart rhythm, and stroke are possible. I certify that I know of no medical problems that would increase my risk of illness and/or injury as a result of participation.

I hereby RELEASE FROM LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS CrossFit Unrivaled (Kastelic Strength and Conditioning, L.L.C), and its owners, trainers, agents, landowners, affiliated companies and employees for any damage, injury, illness or death to myself or to any person or property, whether caused by NEGLIGENCE or for any other reason, in any way connected to the physical condition of the facility, training and adjacent areas. 
Parent Responsibility to Supervise - When I visit CrossFit Unrivaled, or am involved in any related activity involving parental presence or participation, I understand and accept the responsibility, and any associated liability, of constantly supervising, controlling, and restricting activities as necessary to assure the safety of myself and any children I bring to CrossFit Unrivaled facility. I understand that CrossFit Unrivaled is not a daycare center or babysitting facility. I am bringing my children at my own risk. 

I further hereby RELEASE FROM LIABILITY AND AGREE TO INDEMNIFY AND HOLD HARMLESS CrossFit Inc., and its owners, trainers, agents, landowners, affiliated companies and employees for any damage, injury, illness or death to myself or to any person or property, whether caused by NEGLIGENCE or for any other reason, in any way connected to the physical condition of the facility, training and adjacent areas. 

If participant is a MINOR, in exchange CrossFit Unrivaled making CrossFit and related activities and facilities available, the undersigned AGREES TO DEFEND AND INDEMNIFY CrossFit Unrivaled and CrossFit Inc. from any claim for personal injury, illness, death or property damage from said minor, even AFTER the minor has attained MAJORITY and to HOLD CrossFit Unrivaled and CrossFit Inc., their representatives, trainers, agents, officers, directors, and employees HARMLESS from any claim, legal action, harm, injury damages or loss to personal and/or property made on behalf of the aforementioned minor or from THIRD PARTIES injured by the minor. 

In exchange for CrossFit Unrivaled making this facility and property available for CrossFit, I CONTRACTUALLY AGREE that any and all disputes between myself and CrossFit Unrivaled or CrossFit Inc. arising from participation in CrossFit, and including any claims for personal injury and/or death, will be GOVERED BY THE LAWS OF THE COMMONWEALTH OF VIRGINIA and the EXCLUSION JURISDICTION thereof will be in the state of federal courts of the COMMONWEALTH of VIRGINIA

I, furthermore RELEASE CrossFit Unrivaled and CrossFit Inc. to use PHOTOGRAPHS of me, my likeness on their website/or promotional material STRICTLY FOR THE POSITIVE PROMOTION OF CROSSFIT AND ITS AFFILIATES.

I, the undersigned, HAVE READ AND UNDERSTAND the terms of the above FULL AND COMPLETE RELEASE of LIABILITY and INDEMNITY AGREEMENT and I am signing it freely and of my own accord, realizing IT IS BINDING upon me, my heirs, assigns and, in the event that I am signing on behalf of ANY MINORS, that I have FULL AUTHORITY TO DO SO REALIZING ITS BINDING EFFECTS ON THEM as well as me.  I AM AWARE THAT THIS CONTRACT IS LEGALLY BINDING AND THAT BY SIGNING BELOW I AM WAIVING MY LEGAL RIGHTS AS WELL AS THOSE OF ANY MINOR FOR WHOM I AM SIGNING. 

If part of this agreement is deemed unenforceable, the remainder shall be an enforceable contract between the parties. I AM AWARE THAT THIS CONTRACT IS LEGALLY BINDING AND THAT I AM RELEASING LEGAL RIGHTS BY SIGNING IT.

Please select who will be participating...
AdultMinor
Continue
First Participant's Name

First Name*

Last Name*

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

(Please list medications, limitations, injuries, or anything the coaches should know prior to starting you into CrossFit)
First Participant's Signature*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
*RHABDOMYOLYSIS

Is a condition in which damaged skeletal muscle tissue breaks down rapidly. 

The product breakdown is released into the bloodstream and is harmful to the kidneys, left untreated can cause kidney failure. 

Symptoms can include

  • Extreme muscle soreness
  • Vomiting
  • Flu-like symptoms
  • Confusion
  • COLA colored urine

What we do as prevention

We scale the workouts to get you used to the movements, reps, and intensity of CrossFit.

What YOU need to do as prevention

  • KNOW your limits. LISTEN to your body!!!
  • HYDRATE!!!
  • EAT FOR FUEL!!!
  • Be aware that certain medications can raise your risk:
  • Blood Pressure Medications
  • Cholesterol Medications
  • Anti-Inflammatory (prescription/over the counter)

If you experience EXTREME muscle soreness and your urine becomes COLA- like in color, IMMEDIATELY go to the emergency room.

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

(Please list medications, limitations, injuries, or anything the coaches should know prior to starting you into CrossFit)
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver