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Accident Waiver and Release of Liability Form

1)     In consideration for receiving permission to participate in this event, I hereby release, waive, discharge and covenant not to sue Cheer UP Athletics, Ltd., Bay State Athletics, CrossFit Providence LLC, Red Fox Realty, LLC and/or their directors, officers, employees, volunteers, representatives, and agents, and the activity holders, sponsors, and volunteers (collectively, the “releasees”) from any and all liability, claims, demands, actions and causes of action whatsoever arising out of or relating to any loss, damage or injury, including death, that may be sustained by me, or to any property belonging to me, whether caused by the negligence of the releasees, or otherwise, while participating in the event, or while in, on or upon the premises where the event is being conducted, while in transit to or from the event, or in any place or places connected with the event.

 

2)     I am fully aware of the risks and hazards connected with participating in this event, and I am fully aware that there may be risks and hazards unknown to me connected with participating in this event, and I hereby elect to voluntarily participate in this event, and engage in activities knowing that conditions may be hazardous, or may become hazardous or dangerous.  I voluntarily assume full responsibility for any risks of loss, property damage or personal injury, including death, that may be sustained by me, or any loss or damage to property owned by me, as a result of my being a participant in this event, whether caused by the negligence of releasees or otherwise.

 

3)     I represent and warrant to releasees that I am physically fit, I have sufficiently prepared or trained for participation in the activity, I have not been advised to not participate by a qualified medical professional, and there are no health-related reasons or problems which may preclude my participation in this event.

 

4)     I further agree to indemnify and save and hold harmless the releasees and each of them, from any loss, liability, damage or costs they may incur due to my participation in the event, whether caused by the negligence of any or all of the releasees, or otherwise.

 

5)     I hereby consent to receive medical treatment which may be deemed advisable in the event of injury, accident, and/or illness during this activity.

 

6)     I understand while participating in this activity, I may be photographed. I agree to allow my photo, video, or film likeness to be used for any legitimate purpose by the activity holders, producers, sponsors, organizers, and assigns.

 

7)     The Accident Waiver and Release of Liability Agreement shall be construed broadly to provide and release and waiver to the maximum extent permissible under applicable law. If any provision herein is illegal or unenforceable, that provision is severed from this Agreement and the other provisions remain in force. I understand and agree that no oral or written representation can or will alter the contents of this document and that this agreement shall be governed by the laws of Rhode Island without regard to its conflict of law principles.

 

8)     The reference to “I” as used herein binds the participant signing this agreement and, in the event the participant is a minor, also the parent or guardian signing this agreement, to the extent applicable. The undersigned parent(s) or guardian(s) represents and warrants to Releasees that no other individual or entity other than the undersigned parent(s) or guardian(s) may sue on behalf of the participant minor.

 

I CERTIFY THAT I HAVE READ THIS DOCUMENT AND I FULLY UNDERSTAND ITS CONTENT, AND I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT AND I SIGN IT VOLUNTARILY AS MY OWN FREE ACT AND DEED.

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First Participant's Name

First Name*

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

Please List Any Allergies
Grade*
How Did You Hear About Us?*
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*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Parent or Guardian Phone Number

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

Please List Any Allergies
Grade*
How Did You Hear About Us?*
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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