Waiver Form Signature

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Waiver

General Waiver

Golden Phoenix CrossFit

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

If any aspect of this Waiver Agreement requires clarification, have a Golden Phoenix CrossFit, employee fully explain it before signing.By signing the Golden Phoenix CrossFit waiver, you are agreeing to all terms set forth in this WaiverAgreement. You and/or the person on whose behalf you are signing, are waiving the right tobring any type of action,whether in court or otherwise, to recover compensation or obtain any other remedyfor any personalinjuries, damagesto property, any accident or incident of any type, or death, arisingout of or relatedto your use of Golden Phoenix CrossFit, its facilities, grounds, exerciseareas, classes, equipment, whether the use is supervised or unsupervised. Golden Phoenix CrossFit offersthese activities in a controlled environment, there is still an assumed risk of injury to personsusing Golden Phoenix CrossFit. 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 Golden Phoenix CrossFit, its facilities, equipment,classes and/or participating inactivities sponsored by Golden Phoenix CrossFit, have inherent risks. These risks include,but are not limited to, any injury of damage resultingfrom:

 

Negligent misuse of the facility, or equipment of Golden Phoenix CrossFit; fallingoff or impacting againstwalls/floors, impact surface, floors,or anything else; ropeabrasion, entanglement or other activitiesoccurring on the premises;cutsor abrasions resulting from any cause whatsoever; failure of the equipment, whether inside or outside;personal health problems,whether mental or physical;negligence of other climbers, visitors, or observersor persons who may be present in or around the climbing area or facility; and/ornegligence or lack of adequatetraining of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur.


Golden Phoenix CrossFit

1. In consideration of being allowed to participate in the activities and programs of Golden Phoenix CrossFit, CrossFitKids 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 Golden Phoenix CrossFit, CrossFit Kids, Jacqueline and Bridget, and their officers, agents, employees, representatives, executorsand allothers from any and all, responsibilities or liability from injuries or damages resulting frommy participation in any activities or my use of equipment, classes, or machinery in the above mentioned activities. I do hereby release all of those mentioned and any others actingupon their behalf from any responsibility or liability for any injury or damage to myself,including those caused by the negligent act or omissionof any of those mentioned or others acting on theirbehalf or in any way arising out of or connected with my participation in any activitiesof Golden Phoenix CrossFit, CrossFit Kids or the use of any equipment at Golden Phoenix CrossFit, CrossFit Kids.(Please initial)

 

2. I understandand am aware that, fitness,including the use of the equipment, are all potentially hazardous activities. I also understandthat fitness activities involve a risk of injury or even death, and that I am voluntarily participating in these activities andusingequipment and machinery with knowledge of the dangers involved. I hereby to expressly assume and accept any and all risks of injuryor death. (Please initial)

 

3. I do hereby declare myself to be physicallysound and sufferingfrom no condition,impairment, disease, infirmity, or other illness that would preventmy participation or use of equipment, or machinery exceptas herein stated.I acknowledge that I have eitherhad 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 the use of the equipment, and machinery withoutthe approval of my physician and do hereby assume all responsibility for my participation and activities, and utilization of equipment and machinery in myactivities.(Please initial) ___ ___

Print Name _Signature_ Date _ Parent and/or Guardian must sign below for minors:

AGREEMENT AND RELEASE OF LIABILITY

 

In considerationof havingGolden Phoenix CrossFit, CrossFit Kidsallowmy child,

, who is under the age of 18 to participate in the activities and programs of Golden Phoenix CrossFit, CrossFit Kids, including but not limited to Golden Phoenix CrossFit, CrossFit Kids, anyother equipment, I hereby for my child’s heirs, executors,administrators, and or assigns, waive and release any and all rights and claims of any nature my child may have against Golden Phoenix CrossFit, CrossFit Kids, its officers,employees, agents, chapters, assignees, licensees, and cooperating entities, their representatives, heirs, executors, administrators, successors, and assigns for and against any and all injuries or damages of any nature my child may sufferwhile taking part in any activitiesconnected with Golden Phoenix CrossFit, CrossFit Kids. This release and consentshall be binding upon my child’s heirs, executors, administrators, and/or assigns. (Please initial) _

 

PARENT’S/GUARDIAN’S SIGNATURE _ DATE

Ph ot o / Vi d e o R el ea s e

I hereby give permissionfor images of my child, captured during regular and special activities through video, camera and digital camera to be used solely for the purposesof Golden Phoenix CrossFit, CrossFit Kids or Golden Phoenix CrossFit, promotional material,publications and web site,andwaive any rights of compensation or ownership thereto.Last names of minors will not be given or postedon the web site.

 

Name of minor _Name of Parent/Guardian

 

Signature Date

 

 

 

 

 

 

Normal 0 false false false false EN-US JA X-NONE

RHABDOMYOLYSIS ("RHABDO”) RELEASE AND WAIVER

 

 

I, ,inconsideration for continuedaccess to thetraining facilityidentified herein as

, do hereby acknowledge the significant risks associated with the physical training and programing at this facility.I acknowledge and attest to having fully and carefully read and reviewed this "RELEASE AND WAIVER”including all subparagraphs prior to engagingin any physical activityat this facility.

 

(Initials)

Rhabdomyolysis (hereinafter referred to as "Rhabdo”) can occur when an individual’s physical activity is so

 


 

(Initials)


intense that muscular cellsbegin to breakdown andthe contents and/or remaining materialsenter the bloodstream. Rhabdo may be caused by many other systemic or environmental causes. However, Exertional Rhabdo can occur in athletesof all levels of fitness,resulting in muscle cell destruction. The skeletal muscle breakdown impairs kidney function as those organs are unable to handle increasedenzymes that are releasedinto the bloodstream. This induces severe physiological changes in the body. The symptomsof Rhabdo include muscle pain, stiffness and extremeweakness, darkening of the urine (similarto the color of tea or cola), decreased urine output, altered mental status, swelling of the body part involved, either with or without pain. A Rhabdo symptom is pain out of proportion to the amount of sorenessthat one would generallyexpect, often producing pain much quicker than one wouldexpect after a workout.


 

(Initials)

I understand that any concerns on my part that I am experiencing any of the symptoms of Rhabdorequire

 


 

(Initials)


immediatepresentation to a hospital for emergency treatment. I acknowledge that no third party, either from the facilityor otherwise, will be capable of monitoring my urine outputor color, and it is my responsibility to be continually cognizant of this symptom and all other symptomsand to monitor them in my own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concernsregarding possible symptoms of Rhabdo.I understand that statistically individuals most likely to experience Rhabdo are those who are in good shape by generalstandards or who were previously in good physicalshape. This includes individuals who were prior athletes. I acknowledge that often the more mentallytough an athleteis and the more athletic they were in the past or currentlyare, the greater the risk of exposure to Rhabdo.


 

I agree to monitormyself in a manner that is proportionate to the potentialinjury that can be occasioned by this


 

(Initials)


condition. I acknowledge and understand that I am the only individual capable of determining if I am experiencing Rhabdo symptoms. I herebyagree and do willinglyassume responsibility for any risks that I exposemyself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding physicalactivity. I formyself and on behalf ofmyheirs, assigns, personal representatives and/or next ofkin, forever WAIVE, RELEASE, DISCHARGE andCOVENANT NOT TOSUE

(Initials)

and/or their officers,directors, representatives, partners, officials, principals, agents or employees,subsidiaries, or assigns,as well as their independent contractors.

 


 

 

 

Date Signature

 

I hereby acknowledge that I have witnessed that the above party has fully read this document and has been given the opportunity to ask any questions that he/she mayhave regarding its contents.

 

 

 

Date Signatureof Witness

 

 

There is a wealth of medicaland popular information regarding the condition known asRhabdomyolysis available onthe internet. It is stronglyrecommended that you review and evaluate information from all sources available to you,including your physician, prior to executing thisRelease or participating instrenuous physical activity.

 

 

This document was created by Morrow & Milberg, P.A., Plantation, Florida. Tel. (954) 316-1976.

 



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