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BALLSTON CROSSFIT & CROSSFIT ROUTE 7 RELEASE OF LIABILITY/ASSUMPTION OF RISK AGREEMENT

Ballston CrossFit/CrossFit Route 7 recommends that you clear your participation in any exercise program with your physician. I hereby certify that I am not aware of any medical problems, physical impairments/illnesses that will endanger myself or others or that would increase my risk of illness and injury as a result of participating in a fitness program designed by Ballston CrossFit, CrossFit Route 7, Pura Vida Enterprises, LLC, Silver Line Fitness LLC, and/or Tucker Jones (hereinafter collectively “Ballston CrossFit/CrossFit Route 7”). I acknowledge that I have chosen to participate in one or more physical fitness programs/classes/individual training provided by Ballston CrossFit/CrossFit Route 7. I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Ballston CrossFit/CrossFit Route 7 programs/classes. I accept full responsibility for any injury, illness or death that may result from participation in any activity, class or physical fitness program associated with Ballston CrossFit/CrossFit Route 7. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Ballston CrossFit/CrossFit Route 7.

 

Ballston CrossFit/CrossFit Route 7 has made me fully aware that the fitness programs/classes which they offer and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I, the undersigned, recognize and understand that the programs/classes are not without varying degrees of risk which may include, but are not limited to the following: injury to the musculoskeletal and/or cardio respiratory systems which can result in serious injury or death, exposure to illness while utilizing the facility, 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, or injury or death due to a medical condition, whether known or unknown by me, I am aware that any of these above mentioned risks may result in serious injury, illness or death to myself and/or my partner(s).

 

Ballston CrossFit/CrossFit Route 7 informed me that there exists the possibility of adverse physical changes during an exercise program. Ballston CrossFit/CrossFit Route 7 informed me that these changes could include, but are not limited to, abnormal blood pressure, rhabdomyolysis, fainting, disorder of heart rhythm, fainting, stroke, and in very rare instances, heart attack or even death. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Ballston CrossFit/CrossFit Route 7 fitness programs/classes. I assume all risk for my health and well-being and hold Ballston CrossFit/CrossFit Route 7, as well as its owners, employees and other authorized agents including independent contractors, harmless there from.

 

Indemnification: I recognize that there is risk involved in the types of activities offered by Ballston CrossFit/CrossFit Route 7. Therefore, I accept financial responsibility for any injury or illness that I may cause either to myself or to any other participant due to my negligence. Should the above mentioned parties, or anyone acting on their behalf, be required to incur attorney’s fees and defense costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify, defend, and hold harmless Ballston CrossFit/CrossFit Route 7, their principals, agents, employees, and volunteers from liability for the injury, illness and/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 Ballston CrossFit/CrossFit Route 7.

 

COVID-19 Assumption of Risk and Liability Waiver:Please understand that despite all the precautions that you, other members, and/or Ballston CrossFit/CrossFit Route 7 may take, we cannot guarantee your health or safety, and you may still be exposed to COVID-19, including through interactions with other individuals who have COVID-19. By executing this release and gaining access to the facility, you, on behalf of yourself, your heirs, beneficiaries, representatives, successors and assigns: (1) voluntarily assume all risks associated with any exposure to COVID-19, including, but not limited to suffering any type of medical condition, illness and, potentially, death; and (2) knowingly and voluntarily waive, release, covenant not to sue, forever discharge, indemnify, and hold harmless Ballston CrossFit/CrossFit Route 7, its parents and subsidiaries and their respective officers, directors, employees, contractors, agents, representatives, successors and assigns (“Released Parties”) from any and all liability, damages, losses, suits, demands, causes of action to the fullest extent permitted by the laws of this state, or any other claims of any nature whatsoever, arising out of or relating in any way to your use of the facility and your potential exposure to COVID-19.

Waiver and Release:In full consideration of the above mentioned risks and hazards and in full consideration of the fact that I am willingly and voluntarily participating in the activities (including strenuous exercise programs) made available by Ballston CrossFit/CrossFit Route 7, I accept full responsibility for my health and any results, injury, illness or mishaps that may affect my well-being or health in any way. I voluntarily waive any claims, demands, damages of any kind, causes of action or any claims for relief whatsoever against, and release Ballston CrossFit/CrossFit Route 7 (as well as its owners, employees and other authorized agents including independent contractors and volunteers) from any and all liability, claims, demands, actions and/or rights of action that I may have for injuries or other damages, arising from, or in any way connected with, my participation in Ballston CrossFit/CrossFit Route 7 activities, including, but not limited to programs, classes, activities, personal training and nutritional programs. In signing this document, I fully recognize and understand that if I (or any minor on whose behalf I am signing this release) am injured, die, or my property is damaged, I am giving up my right to make a claim or file a lawsuit against Ballston CrossFit/CrossFit Route 7, even if they negligently or by some other act or omission cause the injury or damage. 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.

 

Photo/Video Release:I grant Ballston CrossFit/CrossFit Route 7 permission to use my photograph/video image in any and all publications for CrossFit or Ballston CrossFit/CrossFit Route 7, including editorial, promotional, advertising, marketing materials and usage on web sites, without payment or any other consideration in perpetuity. I hereby authorize Ballston CrossFit/CrossFit Route 7 to edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge Ballston CrossFit/CrossFit Route 7 from all claims, demands, and causes or action which I may have by reason of this authorization.

 

I have fully read and fully 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, illness or death of any person and damage to property caused by my negligent or intentional act or omission. I fully understand the foregoing assumption of risk and release of liability and I understand that by signing it I have released any and all claims against Ballston CrossFit/CrossFit Route 7. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, of my own free will and that I am waiving valuable legal rights. 

Today's Date: September 29, 2022

First Client's Name

First Name*

Middle Name

Last Name*

Phone*
First Client's Date of Birth*
First Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
First Client's Signature*
Second Client's Name

First Name*

Middle Name

Last Name*
Second Client's Date of Birth*
Second Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Third Client's Name

First Name*

Middle Name

Last Name*
Third Client's Date of Birth*
Third Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Fourth Client's Name

First Name*

Middle Name

Last Name*
Fourth Client's Date of Birth*
Fourth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Fifth Client's Name

First Name*

Middle Name

Last Name*
Fifth Client's Date of Birth*
Fifth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Sixth Client's Name

First Name*

Middle Name

Last Name*
Sixth Client's Date of Birth*
Sixth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Seventh Client's Name

First Name*

Middle Name

Last Name*
Seventh Client's Date of Birth*
Seventh Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Eighth Client's Name

First Name*

Middle Name

Last Name*
Eighth Client's Date of Birth*
Eighth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Ninth Client's Name

First Name*

Middle Name

Last Name*
Ninth Client's Date of Birth*
Ninth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Tenth Client's Name

First Name*

Middle Name

Last Name*
Tenth Client's Date of Birth*
Tenth Client's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Client'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:*
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*

As a parent or legal guardian of a Ballston CrossFit/CrossFit Route 7 participant under 18 years of age, I have read and voluntarily agree that said minor may participate in these fitness programs/classes, and I sign this release on their behalf and on the behalf of the minor’s parents and legal guardians. In addition, I also give full permission for any person connected with Ballston CrossFit/CrossFit Route 7 to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call 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. 




By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
New Member
Free Beginner Class
Local Drop-in (Free Trial)
Out of Town Drop-in
Fee paid*
Free Trial Class
$25
$45 (Drop-in + shirt)
$75 1 week
$95 (1 week + shirt)

Date and time of Drop-in

Lead Coach
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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