Please read this waiver, and then answer the following questions.
Note: if you are completing this for your child, answer the questions for him/her, not for you.
2192 S Solomons Island Rd, Suite 2, Prince Frederick, MD
10735 Town Center Blvd #10, Dunkirk, MD 20754
43915 Commerce Ave Unit 5/6, Hollywood, MD 20636
2192 S Solomons Island Rd, Suite 3, Prince
Frederick, MD 20678
WAIVER OF LIABILITY
I, the Member
undersigned below, have volunteered to participate in Calvert CrossFit, Calvert
CrossFIt North, CrossFit Lakas, Iron Foundry Athletics and CrossFit Kids
(hereinafter "the above facilities”) classes or programs of physical exercise
now and in the future (together "the Class”). I understand that there is an
inherent risk associated with any exercise program—including my voluntary
participation in the Class—that may result in injury, even serious or
disabling, or death, and that this risk is always present and cannot be
entirely eliminated. I hereby voluntarily and expressly assume the risks
inherent in my participation in the Class, including the risk of injury,
accident, death, loss, cost or damage to my person or property.
In consideration of the
above facilities’ agreement to instruct, assist, and train me in the Class, I
hereby agree to the following:
and Waiver of Liability.
1. By signing this
Agreement, I hereby waive and release the above facilities, its members,
employees, trustees, contractors, volunteers, representatives, agents, and
successors, and anyone else acting for or on its behalf, and the owner/lessor
of the premises, or anyone using the above facilities premises whether related
to the Class or not, from any and all liability present, past and in the future
relating to or arising out of the Class. I hereby on behalf of myself, my
spouse, heirs, assigns, executors, administrators, agents, successors, legal
representatives or any others who may claim on my behalf, promise not to sue,
and hereby forever irrevocably waive, release, remise and discharge the above
facilities from any and 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 the Class or any other programs offered
or sponsored by the above facilities or attending the above facilities related
events, both on and off of the above facilities premises. This Release and
Waiver applies to all claims, foreseen or unforeseen, including negligence and
breach of statutory or other duty of care. I understand and agree that this
Agreement and Release and Waiver is intended to be as broad and inclusive as
permitted by law. This Release and Waiver includes, without limitation,
injuries which may occur as a result of equipment that may malfunction or
break; any slip or fall within premises; and ailments during and/or post Class
instruction. I UNDERSTAND THAT I HAVE FORFEITED MY RIGHTS TO SUE ANY OF THE
ABOVE FACILITIES, AND THAT THIS IS A RELEASE OF LIABILITY THAT IS VALID
2. In agreeing to this 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 the above facilities, equipment, climbing walls, classes and/or participating in activities sponsored by the above facilities have inherent risks. These risks include,
but are not limited to, any injury of damage resulting from: Negligence of
employees, volunteer assistants, independent contractors of the above
facilities. Negligent misuse of the facility, climbing walls, or equipment of the
above facilities; falling off or impacting against the climbing walls, impact
surface, floors, or anything else; rope abrasion, entanglement or other
activities occurring on the premises; cuts or abrasions resulting from any
cause whatsoever; failure of the climbing walls or equipment, whether inside or
outside; personal health problems, whether mental or physical; negligence of
other climbers, visitors, or observers or persons who may be present in or
around the climbing area or facility; and/or negligence or lack of adequate
training of any person(s) who seek to assist with medical or other help either
before or after any injury or damage may occur.
of Publicity Release and License. I grant the above facilities and its members, representatives, employees, affiliates, subsidiaries, licensees, successors and assigns (collectively referred to herein as "the above facilities”), the right to take photographs of me and my property in connection with its business.
1. I further
irrevocably grant exclusive permission to the above facilities to use, publish,
copyright and reproduce, my name, likeness, identity, image, voice, personal
story, oral or written statements, and/or appearance as such may be embodied in
any pictures, photographs, video recordings, audiotapes, digital images, and
the like, taken or made on behalf of the above facilities (collectively
referred to herein as the "Authorized Works”), for any purposes in connection
with its business (including but not limited to purposes of publicity,
illustration, web content, public relations, editorial, or other advertising or
trade purposes), and without restriction as to frequency or duration. I agree
that the above facilities may use such Authorized Works with or without my
name, and I grant the above facilities the unrestricted right to use a
fictitious name in connection with the Authorized Works.
2. I further
irrevocably grant the above facilities all right, title, and interest that I
may have in any of the Authorized Works, including any negatives, original
prints, or reproductions thereof. This permission includes but is not limited
to the entire copyright in any Authorized Works and/or the right for the above
facilities to reproduce, modify, sell, transfer, distribute, and/or publicly
display any Authorized Works.
3. I understand and
acknowledge that, as a result of this Release, the above facilities shall have
the unrestricted right to any Authorized Works. I irrevocably release my rights
of publicity, editorial rights, inspection rights, or any other rights with
respect to the Authorized Works. I further irrevocably waive the right to
receive any payment for signing this Release and/or for the above facilities use,
publication, reproduction or copyright of any of the Authorized Works. I hereby
irrevocably release the above facilities from any and all claims arising out of
or relating to the Authorized Works. The permissions granted in this Release
extend to all languages, media, formats and markets now known or hereafter
devised, and are granted regardless.
4. If any provision
of this Release or the application thereof to any person or circumstance shall
be invalid, illegal or unenforceable to any extent, the remainder of this
Release and the application thereof shall not be affected and shall be
enforceable to the fullest extent permitted by law. This Release constitutes
the entire agreement between the parties and supersedes all previous agreements
on this matter. There are no other written or oral agreements, representations,
or understandings with respect to the subject matter of this Release.
5. I warrant that I
am at least eighteen (18) years old and have the right to grant this Release. I
have read this Release, understand its terms, and enter into it freely.
C. Indemnification. I agree to indemnify and hold harmless the above facilities officers, directors, employees, authorized agents, to include independent contractors, or volunteer interns 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 the above facilities. I recognize that there is risk involved in the types of activities offered by the above facilities. Therefore, I accept financial responsibility for any injury that I may cause either to myself or to any other participant due to my negligence. Should the above-mentioned parties, or anyone acting on their behalf, be required to incur attorney fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs.
and Assumption of the Risk.
1. I am aware that
specific risks vary from within the Class and the risks range from minor
injuries to major injuries, such as catastrophic injuries including death. I
affirm that I alone am responsible for deciding whether to participate within
the Class, and I understand that I am free to stop participating in the Class
at any time.
2. I acknowledge that
I take full responsibility for my life and well being, as well as the lives and
well being of my Child and family, and all decisions made by me and my Child
and family during and after the Class. I hereby expressly assume the risks of the
Class, including the risk of injury, accident, death, loss, cost or damage to
my person, my family and my children, or my property.
3. I represent that I
am in good health and have no disability, impairment, injury, disease, or
ailment, preventing me from engaging in active or passive exercise or which
could cause increased risk of injury or adverse health consequences as a result
of exercise. I affirm that I have disclosed any and all physical limitations,
disabilities, ailments, or impairments which may affect my ability to
participate in the Class. I assume the responsibility to update the above
facilities of any changes in my medical condition now or in the future that
might affect my safety or participation in the Class prior to the commencement
of any such Class, and I understand that the above facilities shall not be
liable should I fail to do so. If I am pregnant or become pregnant or am
post-natal, my signature verifies that I am participating in the Class with my
doctor’s full approval.
4. I understand and
acknowledge that the above facilities does not manufacture fitness or other
equipment at its facilities, but purchases and/or leases equipment. I also
understand and acknowledge that the above facilities is providing recreational
services and shall not be held liable for defective products.
5. I understand that
the above facilities does not diagnose illness, disease or any other mental or
physical disorder, or prescribe medical treatment of pharmaceuticals. I
understand and acknowledge that the above facilities is providing non-medical
services, and the Class is not a substitute for medical attention, diagnosis or
treatment and that it is recommended that I see a medical practitioner for any
physical ailment that I may have. I understand and agree that the above
facilities may not be held liable for my injuries sustained as a result of the
Class or Instructor counseling provided to me.
E. Rules and Regulations. I agree to abide by the rules, regulations and
schedules of the above facilities as stated herein, as well as those that may
be posted at the facility, on the above facilities website, or issued orally,
and which may be amended from time to time at the above facilities’ sole
discretion (together the "Rules and Regulations”).
Schedule. Class schedule is subject to change, and Class may be cancelled due to unexpected circumstances. The above facilities reserves the right to change the Class schedule at any time, including the addition or the deletion of the Class, as well as changes in Instructors, Class times and length of the Class. The above facilities also reserves the right to cancel Classes or modify hours of operation for repair, maintenance or special occasions. Attendance is based on a first-come, first-serve policy.
G. Minor Children: I understand that I may bring my minor child to the
above facilities while I participate in Classes, but that I do so at my own
risk and that of my minor child. I understand the above facilities accepts no
responsibility for any damage, injury or loss that I or my child may sustain
while on the premises of the above facilities. I understand that the above
facilities does not offer child care of any sort and that no employee, agent,
independent contractor or owner of the above facilities will be watching my
child while I take Class. My child and his or her actions are my responsibility
while I participate in Class at the above facilities.
H. Loss of Property. I understand and agree that the above facilities will provide an area for my personal belongings to be held during the Class; however, I understand and agree that all such personal belongings are brought at my sole risk as to such property’s theft, damage, or loss. I am aware that I should not bring valuables onto the premises of the above facilities, and I understand and agree that the above facilities shall not be liable for the disappearance, loss, theft, or damage to my personal property, including but not limited to money, negotiable securities, items left in coat check lockers, or jewelry. Lost and found articles not claimed will be donated to charity.
I. Emergencies. I
hereby consent to receive first aid from the above facilities in the event of
an accident, injury or illness during the Class and I give the above facilities
permission to seek emergency medical services for me in those circumstances and
agree that I am responsible for any expenses incurred. I hereby agree to hold
harmless and indemnify the above facilities from any and all Liability arising
as a consequence of the above facilities providing first aid/or seeking
emergency medical services for me.
J. Rhabdo Notice.
1. I do hereby
acknowledge the significant risks associated with the physical training and
Rhabdomyolysis (hereinafter referred to as "Rhabdo”) can occur when an
individual’s physical activity is so intense that muscular cells begin to
breakdown and the contents and/or remaining materials enter the bloodstream.
Rhabdo may be caused by many other systemic or environmental causes. However,
Exertional Rhabdo can occur in athletes of all levels of fitness, resulting in
muscle cell destruction. The skeletal muscle breakdown impairs kidney function
as those organs are unable to handle increased enzymes that are released into
the bloodstream. This induces severe physiological changes in the body. The
symptoms of Rhabdo include muscle pain, stiffness and extreme weakness,
darkening of the urine (similar to 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
soreness that one would generally expect, often producing pain much quicker
than one would expect after a workout.
2. I understand that
any concerns on my part that I am experiencing any of the symptoms of Rhabdo
require immediate presentation to a hospital for emergency treatment. I
acknowledge that no third party, either from the facility or otherwise, will be
capable of monitoring my urine output or color, and it is my responsibility to
be continually cognizant of this symptom and all other symptoms and 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
concerns regarding possible symptoms of Rhabdo.
3. I understand that
statistically individuals most likely to experience Rhabdo are those who are in
good shape by general standards or who were previously in good physical shape.
This includes individuals who were prior athletes. I acknowledge that often the
more mentally tough an athlete is and the more athletic they were in the past
or currently are, the greater the risk of exposure to Rhabdo.
4. I agree to monitor
myself in a manner that is proportionate to the potential injury that can be
occasioned by this condition. I acknowledge and understand that I am the only
individual capable of determining if I am experiencing Rhabdo symptoms. I
hereby agree and do willingly assume responsibility for any risks that I expose
myself to and accept full responsibility for any injury or death that may
result from participating in this significantly demanding physical activity.
5. There is a wealth
of medical and popular information regarding Rhabdo available on the Internet. The
above facilities strongly recommend that you review and evaluate information
from all sources available to you, including your physician, prior to executing
this Release and Waiver or participating in strenuous physical activity.
I ACKNOWLEDGE THAT I
HAVE THOROUGHLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I
voluntarily and knowingly agree to the terms and conditions stated herein. I
recognize that BY SIGNING THIS DOCUMENT, I AM WAIVING CERTAIN LEGAL RIGHTS,
INCLUDING ANY RIGHT I OR MY heirs, next OF KIN, executors, administrators and
assigns MIGHT HAVE TO BRING A LEGAL ACTION OR ASSERT A CLAIM AGAINST THE ABOVE
FACILITIES. I intend for my signature to be a complete and unconditional
release of liability OF THE ABOVE FACILITIES to the greatest extent permitted
PARENTAL CONSENT, (for participants
under the age of 18) I, the undersigned parent or legal guardian of the child
shown above, have read the above and understood the foregoing assumption of
risk, and release of liability and agree to its terms on behalf of my child and
myself. I understand that by signing below, I am giving up substantial rights
on behalf of my child and myself.
Please answer the following questions: