Loading...

Worthy Health & Fitness / CrossFit Worthy Waiver

Photography/Video Release:

Participants involved in any activities offered by Worthy Health & Fitness may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the Worthy website or in any editorial, promotional or advertising material produced and/or published by Worthy.


Waiver & Release of Liability:

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; and strains. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and my partner(s). 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 the direction of Worthy Health & Fitness.

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 offered by Worthy Health & Fitness, I , the undersigned hereby release Worthy Health & Fitness, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, rise out of, or are 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 the 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 Worthy Health & Fitness 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.

The participant recognizes that there is risk involved in the types of activities offered by Worthy Health & Fitness. Therefore, the participant accepts financial responsibly for any injury that the participant may cause to him/herself or to any 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 Worthy Health & Fitness, 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 Worthy Health & Fitness, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and /or any area selected for trained by Worthy Health & Fitness.


I have read and understood the foregoing assumption of risk, and release liability and I understand that by signing it obligates me to indemnify the parties’ names 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.

January 2, 2026

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

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Information

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
Parent or Guardian's Email Address
Email*
Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact
First Name*
Last Name*
Emergency Contact's Phone Number*
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(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.


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

Health Questions:

Do you smoke/vape?*
No
Yes
Are you currently active?*
No
Yes
Do you currently have back, knee, or shoulder pain? *
No
Yes
Do you have any previous injuries or surgeries? *
No
Yes
Do you currently have high blood pressure, asthma, diabetes, or a heart condition?*
No
Yes
Take prescription medication?*
No
Yes

If yes to any of the above, please explain:
Any other health conditions not listed?
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!