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The Pack CrossFit
2346 Eldridge Ave
Twin Falls, Idaho 83301

Waiver and Release of Liability

Express assumption of risk:  I, the undersigned, am aware that there are significant risks involved in all aspects of physical training.  These risks include, but are not limited to: falls 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.  I am aware that any of these above mentioned risks may result in serious injury or death to myself my minor child and or my partner(s).

I willingly assume full responsibility for the risks that I am exposing myself and or my minor child to and accept full responsibility for any injury or death that may result from participation in any activity or class while at The Pack CrossFit.  I, the undersigned acknowledge that neither I nor my minor child have any physical impairments or illnesses that will endanger myself or others. 


       

Release:  In consideration of the above mentioned risks and hazards and in consideration of the fact that I (and or minor child) am willingly and voluntarily participating in any and all of the activities available at The Pack CrossFit.  I, the undersigned, hereby release The Pack CrossFit & their principals, agents, employees, 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 this activity, 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.

If I am signing on behalf of a minor child, I also give full permission for any person connected with The Pack CrossFit 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.

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by The Pack CrossFit. Therefore the participant accepts financial responsibility for any injury that 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 attorney’s 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 The Pack CrossFit,  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 The Pack CrossFit.

Payment/Cancelation:  Payment is due no later than the 5th of the month if you are paying by check or cash.  Credit cards are run on the 1st of the month.  If you need to cancel your membership or place your membership on hold two weeks notice is required.  Refunds are not issued after the payment has run.  


I have read and understood 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.

Dated: November 20, 2024

First Participant's Name

First Name*

Last Name*

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

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Second Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Third Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fourth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Fifth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Sixth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Seventh Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Eighth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Ninth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Tenth Participant's Information

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last 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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also 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

Physical Activity and Medical Questionnaire

1. Has a doctor ever said you have a heart condition and recommended only medically supervised activity?*
No
Yes
2. Do you have chest pain bought on by physical activity?*
No
Yes
3. Do you tend to lose consciousness or fall over as a result of dizziness?*
No
Yes
4. Has a doctor ever recommended medication for your blood pressure or a heart condition?*
No
Yes
5. Do you have a bone or joint problem that could be aggravated by the proposed physical activity?*
No
Yes
6. Are you aware, through your own experience or a doctor's advice, of any other physical reason against your exercising without medical supervision?*
No
Yes
7. Are you over the age of 65 and not accustomed to vigorous exercise?*
No
Yes
8. Are there any other issues your trainer should know about?*
No
Yes

READ ME

ONLY ANSWER THE FOLLOWING QUESTIONS IF YOU ANSWERED YES TO ANY OF THE ABOVE QUESTIONS

9. If you answered YES to any questions 1-8 then have you consulted your physician regarding increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes
10. If you answered NO to question 9, will you consult your physician prior to increasing your physical activity and/or performing a fitness assessment?*
N/A
No
Yes

I certify that the above statements are true and correct. I understand that a Doctor's note may be requested. If a note is requested, I should not proceed with this workout until a note is received.

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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