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General, Professional, Accidental, & Rhabdo Liability Waiver

214 MacArthur Ave, New Windsor, NY 12553

This waiver of Liability, Release, Acknowledgement of Risk, and Indemnification Agreement (“Waiver Agreement”) is intended to be, and is, legally binding. If any aspect of this Waiver Agreement requires clarification, have a FBC New Windsor LLC, employee fully explain it before signing. By signing the FBC New Windsor LLC “Student Registration” you are agreeing to all terms set forth in this Waiver Agreement. You and/or the person on whose behalf you are signing, are waiving the right to bring any type of action, whether in court or otherwise, to recover compensation or obtain any other remedy for any personal injuries, damages to property, any accident or incident of any type, or death, arising out of or related to your use of FBC New Windsor LLC, its facilities, grounds, climbing walls, exercise areas, classes, equipment, whether the use is supervised or unsupervised. While Brand FBC New Windsor LLC offers these activities in a controlled environment, there is still an assumed risk of injury to persons using FBC New Windsor LLC. In agreeing to this Waiver Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon behalf of the person for whom I am signing, that the use of FBC New Windsor LLC, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by FBC New Windsor LLC have inherent risks. These risks include, but are not limited to, any injury of damage resulting from: Negligence of employees, volunteer assistants, independent contractors of FBC New Windsor LLC. Negligent misuse of the facility, climbing walls, or equipment of FBC New Windsor LLC; falling off or impacting against the climbing walls, impact surface, floors, or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers, visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur. FBC New Windsor LLC AGREEMENT AND RELEASE OF LIABILITY 1. In consideration of being allowed to participate in the activities and programs of FBC New Windsor LLC and to use its facilities, equipment and machinery in addition to the payment of any fee or charge, I, for myself, my heirs and assigns, hereby waive, release, and forever discharge FBC New Windsor LLC, and their officers, agents, employees, representatives, executors and all others from any and all, responsibilities or liability from injuries or damages resulting from my participation in any activities or my use of equipment, classes, climbing walls or machinery in the above mentioned activities. I do hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of FBC New Windsor LLC or the use of any equipment at FBC New Windsor LLC.  2. I understand and am aware that, fitness, and climbing including the use of the equipment, are all potentially hazardous activities. I also understand that fitness activities involve a risk of injury or even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby to expressly assume and accept any and all risks of injury or death.  3. I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment, climbing wall or machinery except as herein stated. I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate, in the activity of,  fitness,  and climbing and the use of the equipment, climbing wall and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and  machinery  in  my  activities.  

Rhabdomyolysis (hereinafter referred to 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 or environmental causes. However, Exertional Rhabdo 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, swelling 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 quicker 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 possible symptoms of Rhabdo. I understand that statistically individuals most likely to experience Rhabdo are those 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 experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility 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   COVENANT   NOT   TO   SUE and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors.

TODAY'S DATE: November 22, 2019

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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Information
What are you signing up for? *
Group Training and/or Personal Training
Drop In (Experienced CrossFitters Only)
CrossFit Kids
Special Event or Competition.
Arnis Self Defense Class
Terms and Conditions for Adult Group Training/Personal Training (DOES NOT APPLY TO DROP INS). I understand the following:
There are no contracts and I can cancel at anytime via email.
Refunds are at the discretion of the management.
I authorize FBC New Windsor LLC to charge me for personal training and/or memberships automatically via credit card or checking account.
The rates are $65 per session for 60 minute personal training. $40 per session for half hour personal training.
The full cost IS charged for "no shows". A full or partial cost COULD be charged for cancellations with in a 12 hour period.
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*
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
What are you signing up for? *
Group Training and/or Personal Training
Drop In (Experienced CrossFitters Only)
CrossFit Kids
Special Event or Competition.
Arnis Self Defense Class
Terms and Conditions for Adult Group Training/Personal Training (DOES NOT APPLY TO DROP INS). I understand the following:
There are no contracts and I can cancel at anytime via email.
Refunds are at the discretion of the management.
I authorize FBC New Windsor LLC to charge me for personal training and/or memberships automatically via credit card or checking account.
The rates are $65 per session for 60 minute personal training. $40 per session for half hour personal training.
The full cost IS charged for "no shows". A full or partial cost COULD be charged for cancellations with in a 12 hour period.
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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