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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 places you at risk of a potentially life threatening condition, known as ‘Rhabdomyolysis’ caused by muscle damage and seriously affecting internal organs. CrossFit can cause Rhabdomyolysis. 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.

In consideration of Initiate Health Pty Ltd t/a “CrossFit Brisbane” (47 Clarence St, Coorparoo QLD 4152) allowing me to participate, I acknowledge and understand that I have voluntarily chosen to participate in training activities provided by Initiate Health Pty Ltd t/a “CrossFit Brisbane”, hereafter referred to as “the gym”.

 

I agree that the gym is in no way responsible for the safekeeping of my personal belongings while I attend class.                                                                                      

 

I understand that the training may involve weightlifting, gymnastic movements, strenuous bodyweight exercises and other high exertion activities, and that I am not obligated to perform nor participate in any activity that I do not wish, and that it is my right to refuse such participation at any time during my training sessions. 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 the training and the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack and/or death. I warrant that I do not suffer from any medical condition that may affect my ability to participate safely in strenuous exercise. I also acknowledge that I have been specifically warned about the medical condition “Rhabdomyolysis” and accordingly I have been advised to limit my effort in order to minimise the risks associated with this condition.

 

I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my trainer. I give the gym and the staff of the facilities I train in permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred. If I am signing on behalf of a minor child, I also give full permission for any person connected with the gym 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 to WAIVE ANY AND ALL CLAIMS that I have or may have in the future against the gym, and its directors, officers, employees, agents, volunteers and independent contractors (all of whom are hereinafter collectively referred to as “the Releasees”). I agree to RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the programs, activities and services provided by the gym, due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care.

 

I agree to HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by the releasees. 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.

 

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

 

I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS “INFORMED CONSENT FORM” I AM WAIVING CERTAIN LEGAL RIGHTS (INCLUDING THE RIGHT TO SUE) WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTOR, ADMINISTERS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. ANY QUESTIONS I HAD WERE ANSWERED TO MY FULL SATISFACTION.

First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
First Participants Signature*
Second Participants Name

First Name*

Last Name*
Second Participants Date of Birth*
Second Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please provide details
Participants 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*
Emergency Contact

Emergency Contact's 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.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

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

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Occupation *

Injuries (if none please note) *

Medication that affects your ability to exercise? *

Heart Condition? *

If Yes to any of the above, Please 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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