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4869 SW 60th Avenue
Ocala, FL 34474
www.CrossFitAntics.com
352-789-9065

General Participation Waiver

PLEASE NOTE: This waiver of Liability, Release, Acknowledgement of Risk, and Indemnification Agreement (“Waiver Agreement”) is intended to be, and is, legally binding.

If any aspect of this Waiver Agreement requires clarification, have a CROSSFIT ANTICS, employee fully explain it before signing. By signing the CROSSFIT ANTICS “Student Registration” you are agreeing to all terms set forth in this Waiver Agreement. You and/or the person on whose behalf you are signing, are waiving the right to bring any type of action, whether in court or otherwise, to recover compensation or obtain any other remedy for any personal injuries, damages to property, any accident or incident of any type, or death, arising out of or related to your use of CROSSFIT ANTICS, its facilities, grounds, climbing walls, exercise areas, classes, equipment, whether the use is supervised or unsupervised. While Brand CROSSFIT ANTICS offers these activities in a controlled environment, there is still an assumed risk of injury to persons using CROSSFIT ANTICS. In agreeing to this Waiver Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon behalf of the person for whom I am signing, that the use of CROSSFIT ANTICS, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by CROSSFIT ANTICS have inherent risks. These risks include, but are not limited to, any injury of damage resulting from:

Negligence of employees, volunteer assistants, independent contractors of CROSSFIT ANTICS. Negligent misuse of the facility, climbing walls, or equipment of CROSSFIT ANTICS; falling off or impacting against the climbing walls, impact surface, floors, or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers, visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur.

CROSSFIT ANTICS AGREEMENT AND RELEASE OF LIABILITY

1.In consideration of being allowed to participate in the activities and programs of CROSSFIT ANTICS and to use its facilities, equipment and machinery in addition to the payment of any fee or charge, I, for myself, my heirs and assigns, hereby waive, release, and forever discharge CROSSFIT ANTICS, and their officers, agents, employees, representatives, executors and all others from any and all, responsibilities or liability from injuries or damages resulting from my participation in any activities or my use of equipment, classes, climbing walls or machinery in the above mentioned activities. I do hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of CROSSFIT ANTICS or the use of any equipment at CROSSFIT ANTICS.

2. I understand and am aware that, fitness, and climbing including the use of the equipment, are all potentially hazardous activities. I also understand that fitness activities involve a risk of injury or even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby to expressly assume and accept any and all risks of injury or death.

3. I do hereby declare myself to be physically sound and suffering from no condition,impairment, disease, infirmity, or other illness that would prevent my participation or use of equipment, climbing wall or machinery except as herein stated. I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate, in the activity of, fitness, and climbing and the use of the equipment, climbing wall and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in my activities. 

RELEASE, WAIVER, HOLD HARMLESS, ASSUMPTION OF RISK, DEFEND AND INDEMNIFY AGREEMENT

FOR INFECTIOUS DISEASES INCLUDING COVID-19 RELATED LOSS

WARNING: IMPORTANT NOTICE

BY SIGNING THIS RELEASE, WAIVER, HOLD HARMLESS, ASSUMPTION OF RISK, DEFEND AND INDEMNIFY AGREEMENT FOR INFECTIOUS DISEASES INCLUDING COVID-19 RELATED LOSS (“Agreement”), YOU ARE GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES IN CASE OF ILLNESS, INJURY, OR DEATH (collectively “Loss”), ARISING OUT OF YOUR PRESENCE ON THE CROSSFIT ANTICS PROPERTY (“the Facility”) INCLUDING LOSS ARISING OUT OF THE NEGLIGENCE OF YOU OR THE RELEASED PARTIES (defined below) SPECIFICALLY RELATED TO COVID-19 OR ANY OF ITS MUTATIONS, FORMS, DERIVATIVES, OR OTHER INFECTIOUS DISEASES (collectively “COVID-19”).

I, the undersigned, hereby enter into this Agreement in consideration of my ability and permission to access, utilize, occupy, visit, attend, or otherwise be present at the Facility during and after the COVID-19 pandemic, for any reason, whether or not related to fitness activities. 

1.    Risk of Loss/Protective Measures/No Guarantee:  By signing this Agreement, I hereby acknowledge that I have familiarized myself with the risk of Loss being present at the Facility for any reason whatsoever and the protective measures at the Facility intended to minimize my risk of exposure to COVID-19. I agree the protective measures are satisfactory and sufficient for me to accept and assume the risk of my COVID-19 exposure resulting from accessing, utilizing, occupying, visiting, attending, or otherwise being at the Facility occupied by other individuals; however, I understand and agree that Released Parties cannot guarantee: (a) the protective measures can or will prevent my exposure to COVID-19; (b) will be complied with by all individuals at the Facility; or (c) that others will not act in a negligent manner that may contribute to my Loss or contraction of COVID-19. I agree to fully comply with all protective measures required at the Facility as they now exist or may be revised from time-to-time. I accept full responsibility for my own safety and the sanitization of myself and my personal property and/or other personal property I contact at the Facility. If I am a parent or legal guardian of a minor individual at the Facility, I consent to the minor’s presence at the Facility and agree to remain responsible for the minor’s Loss and minor’s compliance with all required protective measures.  

2.    Medical Attention/Disclosure: I understand and agree that engaging in fitness activities or merely being at the Facility exposes me to inherent risks of injury that may require medical attention including, but not limited to, first aid and/or emergency medical care. I therefore consent to personal contact by Released Parties and/or medical personnel deemed necessary for providing for my care at the Facility and/or the hospital, even at the risk of my exposure to COVID-19. I agree to hold Released Parties harmless for such medical attention and any Loss directly or indirectly resulting therefrom. I agree that in the event I am diagnosed as infected with COVID-19, I authorize medical personnel to provide Vilma Tisdal and/or Corey Tisdal with information regarding my Loss and treatment for contact tracing or any other purpose.

3.    Release/Hold Harmless/Defend/Indemnify: I agree to release, hold harmless, defend, and indemnify CrossFit Antics, Vilma Tisdal, Corey Tisdal, and their respective heirs, beneficiaries, relatives, agents, successors, assigns, trainers, employees, volunteers, contractors, assistants, sponsors, clients, guests, visitors, members, managers, officers, directors, related entities, owners, and others acting on their behalf  (collectively “Released Parties”) from and against any liability, attorneys' fees, costs, or other Loss I may incur arising out of or in any way connected with my exposure to or contraction of COVID-19 as a direct or indirect result of my presence at the Facility whether caused by my negligence or the negligence or other wrong doing of Released Parties (other than willful and wanton or intentional misconduct).

4.    Bound Parties/Governing Law/Jury/No Expiration/Time Limitations/Severability/Modification: I understand and agree the terms of this Agreement are binding on my spouse, partner, family members, heirs, agents, trustees, beneficiaries, representatives, relatives, successors, and assigns and I agree to all the terms and conditions of this Agreement on my own behalf and on behalf of my minor for purposes of permitting our presence at the Facility. In the event of a claim or dispute arising out of or relating to the interpretation or enforcement of this Agreement, I agree Florida law applies, that all disputes surviving this Agreement must be resolved exclusively by the state court in Marion County, and I waive my right to a jury trial. I agree that this Agreement does not expire and that any surviving claims must be brought within one (1) year of the date accrued. If any provision of this Agreement is deemed invalid or unenforceable, the remaining provisions shall be valid and enforceable to the fullest extent of the law. This Agreement can only be modified in writing signed by myself and Vilma Tisdal.

WARNING

BEFORE SIGNING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ AND FULLY UNDERSTAND ALL OF THE INFORMATION IN IT. I ACKNOWLEDGE THAT I DO NOT NEED ANY FURTHER EXPLANATION OF ITS CONTENTS AND WAIVE ANY FURTHER EXPLANATION. I HAVE VOLUNTARILY AGREED TO ITS TERMS AND PROVISIONS, UNDERSTAND AND AGREE THAT I HAVE OTHER FITNESS FACILITIES TO CHOSE FROM, AND I AGREE THAT NO OTHER STATEMENT, REPRESENTATIONS OR INDUCEMENT APART FROM WHAT IS STATED IN THIS AGREEMENT HAVE BEEN MADE TO ME TO OBTAIN MY CONSENT AND MY SIGNATURE.   

 

Today's Date: July 3, 2020

First Participant's Name

First Name*

Last Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
First Participant's Signature*
Second Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Third Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Fourth Participant's Name

First Name*

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

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Referred by
Fifth Participant's Name

First Name*

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

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Referred by
Sixth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Seventh Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Eighth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Ninth Participant's Name

First Name*

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

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PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
Tenth Participant's Name

First Name*

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

PRE-EXISTING CONDITIONS / INJURIES
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Referred by
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*
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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*

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

PRE-EXISTING CONDITIONS / INJURIES
PLEASE TELL US HOW YOU FOUND OUT ABOUT US?*

Referred by
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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