Victor
CrossFit Liability Form
Please fill out COMPLETELY and PRINT CLEARLY.
Name__________________________________________________ Phone__________________________________________________
Emergency
Contact_______________________________________
Phone_____________________________
PLEASE
INTIAL EACH SECTION
___________MEMBER / PARTICIPANT
ACKNOWLEDGMENT AND ASSUMPTION OF RISK AND FULL RELEASE FROM LIABILITY OF Victor
CrossFit, OR IT’S EMPLOYEES, CONTRACTORS, OFFICERS, OR OWNER/S... PARTICIPANT ACKNOWLEDGES THESE
PHYSICAL ACTIVITIES INVOLVES THE INHERENT RISK OF PHYSICAL INJURIES OR OTHER
DAMAGES, INCLUDING, BUT NOT LIMITED TO, HEART ATTACKS, MUSCLE STRAINS, PULLS OR
TEARS, BROKEN BONES, SHIN SPLINTS, HEART PROSTRATION, KNEE/LOWER BACK/FOOT
INJURIES AND ANY OTHER ILLNESS, SORENESS, OR INJURY HOWEVER CAUSED, OCCURRING
DURING OR AFTER PARTICIPANT PARTICIPATION IN THE PHYSICAL ACTIVITIES.
______________MEMBER/PARTICIPANT
FURTHER ACKNOWLEDGES THAT SUCH RISKS INCLUDE, BUT ARE NOT LIMITED TO, INJURIES
CAUSED BY THE NEGLIGENCE OF AN INSTRUCTOR OR OTHER PERSON, DEFECTIVE OR
IMPROPERLY USEDEQUIPMENT, OVER-EXERTION OF A MEMBER, SLIP AND FALL BY MEMBER, OR AN UNKNOWN
HEALTH PROBLEM OF MEMBER.
_______________MEMBER/PARTICIPANT AGREES TO ASSUME ALL RISK AND RESPONSIBILITY
INVOLVEDWITH
PARTICIPATION IN THE PHYSICAL ACTIVITIES, MEMBER AFFIRMS THAT MEMBER IS IN GOOD
PHYSICAL CONDITION AND DOES NOT SUFFER FROM ANY DISABILITY THAT WOULD PREVENT
OR LIMIT PARTICIPATION IN THE PHYSICAL ACTIVITIES.
_______________MEMBER/
PARTICIPANT ACKNOWLEDGES PARTICIPATION WILL BE PHYSICALLY AND MENTALLY
CHALLENGING, AND MEMBER AGREES THAT IT IS THE RESPONSIBILITY OF MEMBER TO SEEK
COMPETENT MEDICAL OR OTHER PROFESSIONAL ADVICE, REGARDING ANY CONCERNS OR
QUESTIONS INVOLVED WITH THE ABILITY OF PARTICIPANT TO TAKE PART IN ACTIVITIES.
_______________MEMBER/PARTICIPANT
ASSERTS THAT HE OR SHE IS CAPABLE OF PARTICIPATING IN THE PHYSICAL ACTIVITIES.
_______________MEMBER/Participant understands photos or video
may be taken during the course of my involvement in THIS EVENT, which may be
used FOR PROMOTIONAL PURPOSES FOR Victor crossfit. PHOTOS AND VIDEOS MAY BE
USED BY Victor crossfit FOR FINANCIAL GAIN AND FOR PROMOTING PRODUCTS AND
SERVICES OF Victor CrossFit.
_______________MEMBER
AGREES TO ASSUME ALL RISK AND RESPONSIBILITY FOR NOT EXCEEDING HIS OR HER
PHYSICAL LIMITS.