Waiver

Name*
First Last
Birth Date*
Address*
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Home Phone
Cell Phone*
Email*
How did you hear about us?
Emergency Contact*
Emergency Phone*

I, __________ am aware that there are significant risks involved in all aspects of physical training. I understand that the reaction of the heart, lungs, and vascular system to exercise cannot always be predicted with accuracy. I understand that there is a risk of certain abnormal changes occurring during or following the exercise which may include abnormalities of blood pressure or heart rate; chest, arm or leg discomfort; transient light-headedness or fainting; and in rare instances, heart attack, stroke or even death. Excessive work can result (in rare cases) in exertional rhabdomyolysis. I should look for signs of excessive soreness, darkened urine, and pain in the kidney areas in the days following particularly intense workout. While this type of injury is relatively 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 my trainer. I understand that the programs and classes offered by Uncommon Fitness (EPUC CROSSFIT) are of nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. 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 partner, or other people around me, injury or death due to improper use or failure of equipment. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).
Initial*
I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Uncommon CrossFit (EPUC) programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. 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 a fitness program designed by Uncommon Fitness (EPUC CrossFit). With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Uncommon Fitness (EPUC CrossFit) programs/classes.
Initial*
By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive, physical exercise. By signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including, but not limited to, abnormal blood pressure, rhabdomyolysis, fainting, heart attack, or death. By signing this document, I assume all risk for my health and well-being and hold Uncommon Fitness (EPUC CrossFit), as well as its owners, employees, and other authorized agents including independent contractors, harmless there from I understand that questions about exercise procedure and recommendations are encouraged and welcome.
Initial*

Waiver and Release
I fully understand that my personal exercise program may be strenuous and I choose to participate voluntarily. I accept all responsibility for my health and any results, injury or mishaps that may affect my well-being or health in any way. I waive any claims, demands, causes of action or any claims for relief whatsoever against, and release Uncommon Fitness (EPUC CrossFit) as well as any of its owners, employees, or other authorized agents, including independent contractors from any and all liability, claims and/or causes of action that I may have injuries or other damages arising out of participation in Uncommon Fitness (EPUC CrossFit) activities, including, but not limited to the personal training, nutritional programs, and programs/classes.
Initial*

Photo/Video Release
I hereby grand Uncommon Fitness (EPUC CrossFit) permission to use my photography/video image in any and all publications for promotions on social media sites, CrossFit or EPUC CrossFit, including website entries without payment or any other consideration in perpetuity. I hereby authorize Uncommon Fitness (EPUC CrossFit) to edit, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release forever discharge Uncommon Fitness (EPUC CrossFit) from all claims, demands, and causes or action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my estate which may have or may have by reason of this authorization.
Initial*

Idemnification
I recognize that there is risk involved in the types of activities offered by Uncommon Fitness (EPUC CrossFit). Therefore, I accept financial responsibility for any injury that I may cause either to myself 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 costs to enforce this agreement, I agree to reimburse them such fees and costs. I further agree to indemnify and hold harmless Uncommon Fitness (EPUC CrossFit), 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 Uncommon Fitness (EPUC CrossFit).
Initial*

Child Liability
All children must remain seated during all training hours. I am responsible for my child/children in anyway. Children are not allowed to roam the facility and will be asked to be seated. I assume the responsibility of my child in case of any injury or possible death and accept full responsibility. Children will be asked to be seated in designated area the entire time and are NOT allowed to play/use Uncommon Fitness (EPUC CrossFit) training equipment to ensure the safety of my child and other. I recognize that there are risks involved in the facility and will be asked to discipline children. This will allow fairness/safety for all other paying members and children.
Initial*

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 that by signing this form I am waiving valuable legal rights.

I have carefully read this agreement and fully understand its contents. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, and of my own free will.
Participant's Name*
Parent/guardian's Name

If the participant is under 18.
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Step 1 of 8

Physical Activity Questionnaire

Waiver and Release

Photo/Video Release

Idemnification

Child Liability