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This agreement must be completed in full, initialed where indicated, dated, signed and witnessed prior to participating in any CrossFit Industrious athletic activities.

Assumption of Risk - Release of Liability - Waiver of Claims & Indemnity Agreement

BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.

Fitness Industrious, LLC, CrossFit Industrious, Owners, Volunteers, Directors, Officers, employees, trainers, instructors, Agents, officials, independent contractors, representatives, successors and assigns (hereinafter referred to as “CrossFit Industrious” or “CFI”).

Photography/Video Release:Participants involved in any activities offered by CrossFit Industrious may be  photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the CrossFit Industrious website or in any editorial, promotional or advertising material published and or published by CrossFit Industrious.

I Agree

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, strains and sprains. 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 or under direction of CrossFit Industrious. 

Furthermore, I understand there are inherent risks in all aspects of physical training and I acknowledge that I have been informed of the possible strenuous nature of CrossFit training and the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness and fainting. I also acknowledge that I have been specifically warned about the medical condition “Rhabdomyolysis” (see bottom of page) and accordingly I have been advised to limit my effort in order to minimize the risks associated with this condition.

I Agree

Release of Liability:  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 Industrious, I, the undersigned hereby release  CrossFit Industrious, 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 CrossFit Industrious 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.

I Agree

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by CrossFit Industrious. 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 Industrious, 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 Industrious in the main building or abroad. This includes, but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by CrossFit Industrious. 

I Agree

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. 

I Agree

Date: May 26, 2019

First Participant's Name

First Name*

Last Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
First Participant's Signature*
Second Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Third Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Fourth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Fifth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Sixth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Seventh Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Eighth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Ninth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
Tenth Participant's Name

First Name*

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
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*
WARNING... Safety first!!!

High intensity exercise must be approached cautiously in the beginning, a gradual ramp up of intensity is necessary to allow muscles cells to adapt to the new demands being placed on them. Failure to do so, opens the door to a life threatening condition, known as 'Rhabdomyolysis'. In short, the muscle cells are damaged flooding the bloodstream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, leading to potential kidney failure. That being said, it is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are warning signs of 'Rhabdo'. If you develop these symptoms, seek medical assistance immediately.

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

Health Assessment

Do you have a family history of heart disease?*
No
Yes
Do you have high blood pressure?*
No
Yes
Do you have Diabetes?*
No
Yes
Do you ever experience dizziness?*
No
Yes
Do you have neck problems?*
No
Yes
Do you have back problems?*
No
Yes
Do you have hip/pelvis problems?*
No
Yes
Do you have knee problems?*
No
Yes
Do you have any current injuries?*
No
Yes
Do you have any allergies?*
No
Yes
Are you currently taking any medication(s)?*
No
Yes
Are you a smoker?*
No
Yes
Are you currently exercising?*
No
Yes
Are there any exercises you know you cannot do due to injury?*
No
Yes
Have you ever participated in strenuous exercise?*
No
Yes
Have you any reason not to participate in strenuous exercise?*
No
Yes
Have you ever experienced shortness of breath or chest pain?*
No
Yes
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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