Waiver

Name*

Your Name

First Last

Date of Birth (MM/DD/YYYY)*

Date of Birth (MM/DD/YYYY)

Address*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email Address*

Email Address

Phone*

Phone

Emergency Contact*

Emergency Contact

First Last

Emergency Phone*

Emergency Phone

Membership Interested In*

Membership Interested In

When do you plan on dropping by?*

When do you plan on dropping by?

Item A*

In consideration of the use of CrossFit Uncompromised facilities and equipment, and in recognition of the possible perils of the use of exercise facilities, the undersigned, for themselves, and their heirs, executors, administrators and assigns do herby release CrossFit Uncompromised, its owners, agents, employees and representatives, as well as its accessors and assigns from any liability, obligation, or responsibility for any injuries sustained from the use of such facilities, against the said CrossFit Uncompromised arising from the use of its facilities and equipment. I do also hereby release all of those mentioned and any other acting upon their behalf from any responsibility or liability for any injury or damage to myself in any way arising out of or connected with my participation in any activities at CrossFit Uncompromised or the use of any equipment of CrossFit Uncompromised.

Item B*

I understand and am aware that strength, flexibility, and aerobic exercise, including the use of equipment, is a potentially hazardous activity. I understand that fitness activities involve a risk of injury and even death, and I am voluntarily participating in these activities and using equipment with knowledge of the dangers involved. Injury may also result simply from the fact of physical training itself – training will push the body beyond its limits to produce a physical adaptation and requires feedback from me and the coach. Excessive work can (in rare cases) result in exertional rhabdomyolosis – I should look for signs of excessive soreness, darkened urine, and pain in the kidney areas in the days following an intense workout. Though rare, it can occur due to a number of factors, including, but not limited to, genetic predisposition or dehydration, that may be beyond the control of the coach. I hereby agree to expressly assume and accept any and all risks of injury or death.

Item C*

I agree to pay attorney fees and litigation expenses incurred by any person, real or corporate, whom I may sue in an effort to challenge this release from liability. I understand that my agreement to pay attorney and litigation expenses is the sine qua non for acceptance to the use of CrossFit Uncompromised.

Photography Release*

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

Health Questionnaire*

This questionnaire is designed to help you determine the need to obtain a physical or consultation from your doctor. IT IS ALWAYS ADVISABLE THAT YOU SEEK THE OPINION OF YOUR PHYSICIAN PRIOR TO STARTING ANY EXERCISE PROGRAM.

If you answer YES to any of the below questions, it is imperative that you seek the advice of your physician prior to starting any exercise program. The question of your physical fitness is ultimately up to you. As with any new exercise program, it is best to take your time and build up slowly to the level of intensity you desire. By understanding your body's limitations, you will safely achieve you fitness goals.

Has a physician ever expressed concern about your heart or blood pressure?*

Has a physician ever expressed concern about your heart or blood pressure?

Do you have any discomfort in your chest?*

Do you have any discomfort in your chest?

Do you often feel faint or have dizzy spells?*

Do you often feel faint or have dizzy spells?

Has a physician ever told you that you may have bone, back, or joint problems that could be aggravated by exercise?*

Has a physician ever told you that you may have bone, back, or joint problems that could be aggravated by exercise?

Have you ever been told by a physician to limit your physical activity?*

Have you ever been told by a physician to limit your physical activity?

Are you aware of anything which would prohibit you from engaging in a vigorous exercise program?*

Are you aware of anything which would prohibit you from engaging in a vigorous exercise program?

Acceptance*

I have read and understood 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. Therefore, I accept financial responsibility for any injury that I may cause to myself or others. I understand that by signing this form I am waiving valuable legal rights.

If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit Uncompromised 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.

Signature*

Parent Signature (if under 18)

Parent Name (if under 18)

First Last

Comments

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