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Waiver and Release of Liability

CrossFit New England
15 Tech Circle

Natick, MA 01760

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 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 participation in any activity or class while at CrossFit New England.
I, the undersigned acknowledge that I have no physical impairments or illnesses that will endanger myself or others.

Use of picture(s)/film/likeness:
I agree to allow CrossFit New England, its agents, officers, principals, employees and volunteers to use picture(s), film and/or likeness of me for advertising purposes.  In the event I choose not to allow the use of the same for said purpose, I agree that I must inform CrossFit New England of this in writing.

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 New England, I, the undersigned hereby release CrossFit New England, 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.

Indemnification:
The participant recognizes that there is risk involved in the types of activities offered by 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 CrossFit New England, 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 CrossFit.

I have read and understand 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.

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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
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*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Physical Activity Readiness Questionnaire (PAR-Q) - Section 1
Has your doctor ever said you have heart trouble?*
No
Yes
Do you frequently have pains in your heart and chest?*
No
Yes
Do you often feel faint or have spells of severe dizziness?*
No
Yes
Is there a good physical reason, not mentioned here, why you should not follow an activity program even if you wanted to?*
No
Yes
Section 2
Has a doctor ever said your blood pressure was too high?*
No
Yes
Has your doctor ever told you that you have a bone or joint problem(s), such as arthritis that has or could be aggravated by exercise, or might be made worse with exercise?*
No
Yes
Are you over age 60 and not accustomed to vigorous exercise?*
No
Yes
Do you suffer from any problems of the lower back, i.e., chronic pain, or numbness?*
No
Yes
Are you currently taking any medications?*
No
Yes

If YES, please specify.
Do you currently have a disability?*
No
Yes
Do you have any crossfit experience?*
No
Yes
If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit New England 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.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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