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RELEASE AND WAIVER OF LIABILITY

PLEASE READ VERY CAREFULLY BEFORE SIGNING

RELEASE AND WAIVER OF LIABILITY

TODAY'S DATE: March 26, 2019

Please read the following carefully. Your signature acknowledges your agreement to all sections of the waiver.

EXPRESS ASSUMPTION OF RISK
I , the undersigned, am aware that there are significant risks involved in all aspects of physical training and competitive sports.  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, loss or damage to personal property, physical exertion and heat exhaustion, and dehydration.  I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).  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 my participation in any activity offered by CrossFit Mercenary: F.A.C./CCA Fitness LLC.  I acknowledge that I have no physical impairments or illnesses that will endanger myself or others.

RELEASE OF LIABILITY
In consideration of the above-mentioned risks and hazards, I am willingly and voluntarily participating in the activities available at CrossFit Mercenary: F.A.C. and I freely and voluntarily wish to use its facilities, equipment, premises, and volunteers/instructors/trainers. I hereby release CrossFit, or CrossFit Mercenary: F.A.C./CCA Fitness LLC, or their principals, agents, officers, 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 my successors, my representatives, heirs, executors, assigns, transferees, and myself.  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 CrossFit or CrossFit Mercenary: F.A.C./CCA Fitness LLC 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 wellbeing of the child. 

CANCELLATION POLICY

I understand and agree that I give CrossFit Mercenary: FAC authority to bill my credit card each month for the membership that I have purchased. I understand and agree that should I wish to cancel, I must provdie written notice of cancellation via email to crossfitmercenary@gmail.com at least 7 days prior to my billing date.  I understand and agree that if I do not give notive of cancellation at least 7 days prior to my billing date, I will be charged for that month. 

USE OF PICTURES/FILM/LIKENESS
I further agree to allow CrossFit Mercenary: F.A.C./CCA Fitness LLC, its agents, officers, principals, employees, and volunteers the use of a picture (s), film, or likeness for advertising purposes.  I authorize CrossFit Mercenary: F.A.C./CCA Fitness LLC to use my name, voice, likeness, and any biographical facts disclosed or provided to CrossFit Mercenary: F.A.C./CCA Fitness LLC in advertising and promoting without compensation. In the event I choose not to allow the use of same for said purposes, I agree that I must inform CrossFit Mercenary: F.A.C./ CCA Fitness LLC of this in writing. 

INDEMNIFICATION
I, the undersigned, recognize that there is risk involved in the types of activities offered by CrossFit or CrossFit Mercenary: F.A.C./ CCA Fitness LLC.  Therefore, I accept full financial responsibility for an injury that I may cause to myself or to any other participant due to my negligence, or the negligence of others.  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 CrossFit or CrossFit Mercenary: F.A.C./ CCA Fitness LLC, their principals, agents, officers, employees, judges, coaches, 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 or CrossFit Mercenary: F.A.C./ CCA Fitness LLC.

All children under the age of 18 are not allowed in or on CrossFit Mercenary: F.A.C/ CCA Fitness LLC premises without adult supervision or legal consent of a guardian.  CrossFit Mercenary: F.A.C./ CCA Fitness LLC is not held liable for any injury or damages to minors in or on the premises. 

I HAVE READ AND UNDERSTOOD THE FOREGOING ASSUMPTION OF RISK AND RELEASE OF LIABILITY, AND I UNDERSTAND THAT BY SIGNING IT OBLIGATES ME TO INDEMINIFY AND HOLD HARMLESS THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY MY NEGLIGENT OR INTENTONAL ACT OR OMISSION.  I UNDERSTAND THAT BY SIGING THIS FORM I AM WAIVING VALUABLE LEGAL RIGHTS.

DATED: March 26, 2019

First Participant's Name

First Name*

Middle Name

Last Name*

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Third Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Fourth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Fifth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Sixth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Seventh Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Eighth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Ninth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
Tenth Participant's Name

First Name*

Middle Name

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

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. Provide details:
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*
Check to receive information, news, and discounts by e-mail.
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*
Billing and Payment
Billing Method*

CARD NUMBER *
EXPIRATION DATE*
EXPIRATION DATE*

Billing Zip Code *

3 Digit Security Code (CVV) *

I hereby authorize this credit card or debit card to be used by CrossFit Mercenary each month for the membership that I have purchased.  I understand and agree that should I wish to cancel, I must provide written notice of cancellation via to crossfitmercenary@gmail.com at least 7 days prior to my billing date.  If I have signed up for a day special pricing trial/groupon month I must provide notice of cancellation.  The standard membership pricing is $150/month.  I understand and agree that if I do not give written notice of cancellation at least 7 days prior to my billing date, I will be charged for that month.

Billing Authorization *
Yes
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*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Please advise of any medical conditions, diseases, operations, disorders, or problems you had or currently have. 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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