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CERBERUS SERIES & HDT THROWDOWN WAIVER


Health Assessment Waiver

INFORMED CONSENT/ASSUMPTION OF RISK

I agree to participate in one or more physical fitness event(s) sponsored by Cleveland Area Rucking Crew, which may include, but not necessarily be limited to, ruck training, and/or training of any kind by any affiliate, subsidiary or partnership of Cleveland Area Rucking Crew and/or Bryan Singelyn (hereinafter collectively referred to as Cleveland Area Rucking Crew or CARC). Cleveland Area Rucking Crew made me fully aware that the events which Cleveland Area Rucking Crew offers 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 events 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 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 or death to myself and or my partner(s).


Date: May 2, 2024

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Cleveland Area Rucking Crew events and accept full responsibility for any injury or death that may result from participation in any activity, event, or physical fitness training. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in an event or physical fitness training designed by Cleveland Area Rucking Crew. Cleveland Area Rucking Crew informed me that there exists the possibility of adverse physical changes during a rucking event and/or physical fitness training, and I fully understand the same. Cleveland Area Rucking Crew informed me that these changes could include abnormal blood pressure, fainting, rhabdomyolysis, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and I fully understand the same. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Cleveland Area Rucking Crew events and/or physical fitness training sessions.


Date: May 2, 2024

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 made available by Cleveland Area Rucking Crew, and with my full understanding of all of the above, I hereby waive, release, remise and discharge Cleveland Area Rucking Crew and its agents, officers, principals, and employees and volunteers, of any and all liability, claims, demands, actions or rights of action, or damages of any kind related to, arising from, or in any way connected with, my participation in Cleveland Area Rucking Crew events and/or physical fitness training, 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 this 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 Cleveland Area Rucking Crew 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 wellbeing of the child.


Date: May 2, 2024

INDEMNIFICATION

I recognize that there is risk involved in the types of activities offered by Cleveland Area Rucking Crew. Therefore I accept financial responsibility for any injury that I or the participant may cause either to him/herself or to any other 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 cost to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Cleveland Area Rucking Crew, their principals, agents, employees, and volunteers from liability for 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 actives offered by Cleveland Area Rucking Crew.


Date: May 2, 2024


USE OF PICTURE(S)/FILM/LIKENESS

I agree to allow Cleveland Area Rucking Crew, its agents, officers, principals, employees and volunteers the picture(s), film and/or likeness of me for advertising purposes through photography and/or your own social media posts in regards to Cleveland Area Rucking Crew LLC and/or Heavy Drop Training events. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Cleveland Area Rucking Crew of this in writing. 


Date: May 2, 2024

USE OF NAME

I agree to allow Cleveland Area Rucking Crew, its agents, officers, principals, employees and volunteers to use my name for advertising purposes in regards to Cleveland Area Rucking Crew LLC and/or Heavy Drop Training events. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Cleveland Area Rucking Crew of this in writing.


Date: May 2, 2024


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 or death of any person and damage to property caused by my negligent or intentional act or omission. I understand by signing this form I am waving valuable legal rights.



First Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
First Participant's Signature*
Second Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Third Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Fourth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Fifth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Sixth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Seventh Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Eighth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Ninth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
Tenth Participant's Name

First Name*

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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
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

First Name*

Last 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.


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

PARTICIPANTS HEALTH ASSESSMENT


Date of Last Full Physical: *
Do you work out at least 3 times a week:*
Are you currently taking medication:*

If yes, explain:
Do you have problems/injuries in any of the following areas including but not limited to your knees, lower back, neck, shoulder, or any other region?*

If yes, explain:
Has your doctor ever said that you have a heart condition and that you should only perform physical activity recommended by a doctor?*
No
Yes
Do you feel pain in your chest when you perform physical activity?*
No
Yes
In the past month, have you had chest pain when you are not performing any physical activity?*
No
Yes
Do you lose your balance because of dizziness or do you ever lose consciousness?*
No
Yes
Do you know of any other reason why you should not engage in physical activity?*
No
Yes

If you answered yes to one or more of the above questions, consult a physician before engaging in physical activity. Tell your physician which questions you answered "Yes" to. After medical evaluation, seek advice from your physician on what type of activity is suitable for your current condition. If you would like to explain your reasoning for choosing "Yes", do so within the text box.
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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