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Below is CrossFit Resilience's Waiver and Release of Liability form.

Express Assumption of Risk: I, the undersigned, hereby expressly and affirmatively state that I have voluntarily chosen to participate in a physical training program managed by CrossFit Resilience. I am fully aware that there are significant risks involved in any physical training program. These risks include, but are not limited to: falls which can result in serious injury, heart attacks, muscle strains, lacerations, broken bones, injuries to joints, abnormal blood pressure, and potentially other injuries or illnesses. I am aware that any of these above mentioned risks might result in serious injury or death. I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while training with CrossFit Resilience. I, the undersigned, also acknowledge that I have no physical impairments or illnesses that have not been revealed on the attached medical form that could endanger others or myself.

I may also receive information or consultationsĀ about Nutrition while at CrossFit Resilience. If I receive such information or if I participate in a Nutrition Program/Challenge, I have done so voluntarily and I am fully aware of the risks associated with this advice or these activities. Further, I willingly assume full responsibility for all of theĀ risks associated with these activities or consultations.

Release: In consideration of the above mentioned risks and hazards, and in consideration of the fact that I am willingly and voluntarily participating in the activities available at CrossFit Resilience, I, the undersigned, hereby release CrossFit Resilience, DCC Consulting LLC, their principals, agents, employees, sponsors, contractors and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in these activities, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon successors, my representatives, heirs, executors, assigns, transferees, or me. 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.

Photo/Video/Audio Release:I, the undersigned, hereby grant CrossFit Resilience permission to use my audio/photography/video images in any and all publications for CrossFit Resilience without payment or any other consideration in perpetuity. I waive the right to inspect or approve the finished product, including written or electronic copies, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph/video images or audio. I hereby hold CrossFit Resilience harmless and release and forever discharge CrossFit Resilience from all claims, demands, and causes of action.

Indemnification: I recognize that there is risk involved in the types of activities offered by this CrossFit program. Therefore I accept financial responsibility for any injury that I may cause either to me or to any other participant due to my negligence. I further agree to indemnify and hold harmless CrossFit Resilience, DCC Consulting LLC, their principals, agents, employees, sponsors, contractors 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 CrossFit Resilience.

I have read and understood the foregoing assumption of risk, release of liability, and indemnification clauses. I also understand that questions about the CrossFit Resilience exercise and /or nutrition program are highly recommended and encouraged.

First Members Name

First Name*

Last Name*

Phone*
First Members Date of Birth*
I certify that I am 18 years of age or older
First Members Signature*
Second Members Name

First Name*

Last Name*
Second Members Date of Birth*
Third Members Name

First Name*

Last Name*
Third Members Date of Birth*
Fourth Members Name

First Name*

Last Name*
Fourth Members Date of Birth*
Fifth Members Name

First Name*

Last Name*
Fifth Members Date of Birth*
Sixth Members Name

First Name*

Last Name*
Sixth Members Date of Birth*
Seventh Members Name

First Name*

Last Name*
Seventh Members Date of Birth*
Eighth Members Name

First Name*

Last Name*
Eighth Members Date of Birth*
Ninth Members Name

First Name*

Last Name*
Ninth Members Date of Birth*
Tenth Members Name

First Name*

Last Name*
Tenth Members Date of Birth*
Members 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*
A signed copy of this waiver will be sent to the email address you provide.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Medical Information
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you do physical activity?*
No
Yes
In the past month, have you experienced chest pain when not performing physical activity?*
No
Yes
Do you lose balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you have a bone or joint problem (i.e. back, knee or hip) that could be made worse by a change in your physical activity?*
No
Yes
Is your doctor currently prescribing drugs (i.e. water pills) for your blood pressure or heart condition?*
No
Yes
Do you know of any other reason why you should not do physical activity?*
No
Yes

If you answered "yes" to any of the proceeding questions, please explain:

Are there any other issues or injuries (i.e. back, knee or shoulder) that we should be made aware of?
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*
I certify that I am 18 years of age or older
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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