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Address *

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Emergency Contact *

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Health Info and Release *

HEALTH INFORMATION If You: Smoke, Drink Alcohol, Take Prescriptions, are not currently exercising, if you have Back Pain, Knee Pain, or Shoulder Pain, have had Previous Injuries or Surgeries, High Blood Pressure, Asthma, Diabetes, or a Heart Condition, or Any other health conditions not listed it is the strong recommendation of Workout UNIT 64, LLC that you seek medical counsel before you proceed with a workout program. WAIVER AND RELEASE OF LIABILITY EXPRESS ASSUMPTON OF RISK: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. 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 people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above mentioned risks may result in serious injury or death to myself and or partner(s). I WILLINGLY ASSUME FULL RESPONSIBILITY FOR THE RISK THAT I AM EXPOSING MY SELF TO AND ACCEPT FULL RESPONSIBILITY FOR ANY INJURY OR DEATH THAT MAY RESULT FROM PARTICIPATION IN ANY ACTIVITY OR CLASS WHILE AT, OR UNDER DIRECTION OF Workout UNIT 64, LLC.

I have read and agree.

Medical Checkup *

MEDICAL CHECKUP: Exercise MAY BE STRENUOUS. SEE A DOCTOR BEFORE STARTING ANY EXERCISE PROGRAM. Participant understands that the activities available with Workout UNIT 64, LLC may involve strenuous physical activity and that a medical check-up is advisable before participating in any fitness program. The undersigned further understands that neither the owners nor employees of Workout UNIT 64, LLC are medical doctors, therefore the participant should see a medical doctor of his/her own choosing before participating in any fitness program. THE UNDERSIGNED RECOGNIZES, APPRECIATES AND UNDERSTANDS THE DANGER OF PHYSICAL Stress, STRAIN OR INJURY (INCLUDING BUT NOT LIMITED TO, CARDIAC ARREST, STROKE, CHANGES IN BLOOD PRESSURE, MUSCLE STRAINS, SPRAINS AND LIGAMENT AND/OR TENDON DAMAGE AND OTHER PHYSICAL PROBLEMS THAT MAY ARISE) THAT MAY RESULT FROM ANY ACTIVITY THAT REQUIRES PHYSICAL EXERTION AND ACCEPTS THESE RISKS.

I have read and agree.

Release *

RELEASE: It is the sole responsibility of each participant to monitor his/her participation and to make the decision on how and to what extent to participate. Participation is not mandatory at any level, and the participant is free to cease participation at any time for any reason. By continuing to participate, the participant assumes any and all risks associated with participation and agrees not to hold Workout UNIT 64, LLC or any of its principals, agents, employees, fellow participants, or volunteers responsible for any losses or damages of any/ nature whatsoever. In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by Workout UNIT 64, LLC, I, THE UNDERSIGNED HEREBY RELEASE Workout UNIT 64, LLC, THEIR PRINCIPALS, AGENTS,EMPLOYEES, FELLOW PARTICIPANTS AND VOLUNTEERS FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, ACTIONS OR RIGHTS OF ACTION, WHICH ARE RELATED TO, ARISE OUT OF, OR ARE IN ANY WAY CONNECTED WITH MY PARTICIPATION IN THIS ACTIVITY, INCLUDING THOSE ALLEGEDLY ATTRIBUTED TO NEGLIGENT ACTS OR OMISSIONS OF THE ABOVE MENTIONED PARTIES. THIS AGREEMENT SHALL BE BINDING UPON ME, MY SUCCESSORS, REPRESENTATIVES, HEIRS, EXECUTORS, ASSIGNS, OR TRANSFEREES. IF ANY PORTION OF THIS AGREEMENT IS HELD INVALID, I AGREE THAT THE REMAINDER OF THE AGREEMENT SHALL REMAIN IN FULL LEGAL FORCE AND EFFECT.

I have read and agree.

Indemnfication

INDEMNIFICATION: The participant recognizes that there is risk involved in the type of activities offered by Workout UNIT 64, LLC. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself 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 cost to enforce this agreement, I agree to reimburse them for such fees and costs. I FURTHER AGREE TO INDEMNIFY AND HOLD HARMLESS Workout UNIT 64, LLC, THEIR PRINCIPALS, AGENTS, EMPLOYEES, FELLOW PARTICIPANTS AND VOLUNTEERS FROM LIABILITY FOR THE INJURY OR DEATH OF ANY PERSON(S) AND DAMAGES TO PROPERTY THAT MAY RESULT FROM MY/ NEGLIGENT OR INTENTIONAL ACT OR OMISSION WHILE PARTICIPATING IN ACTIVITIES OFFERED BY Workout UNIT 64, LLC. PARTICIPANT IS ALSO AWARE, THIS IS A RELEASE OF LIABILITY, A WAIVER OF THE PARTICIPANT’S LEGAL RIGHT TO COLLECT DAMAGES IN THE EVENT OF INJURY, DEATH, OR PROPERTY DAMAGE AND A CONTRACT BETWEEN PARTICIPANT AND Workout UNIT 64, LLC AND PARTICIPANT SIGNS IT OF HIS/HER OWN FREE WILL. PARTICIPANT ALSO ACKNOWLEDGES HE/SHE IS OVER THE AGE OF 18, OF SOUND MIND, AND HAS NOT BEEN COERCED IN ANY WAY TO SIGN THIS WAIVER OF LIABILITY AND CONSENT FORM. THE UNDERSIGNED ALSO CERTIFIES HE/SHE IS COMPLETELY COMPETENT AND AUTHORIZED TO EXECUTE THIS RELEASE AND THE HE/SHE HAS FULLY READ AND COMPLETELY UNDERSTOOD THIS WAIVER OF LIABILITY AND CONSENT FORM OR HAS HAD IT EXPLAINED TO HIM/HER.

I have read and agree.

Express Consent for Medical Treatment *

EXPRESS CONSENT FOR MEDICAL TREATMENT: I EXPRESSLY GIVE MY CONSENT FOR THE STAFF AND COACHES OF CrossFit UNIT 64, LLC TO OBTAIN MEDICAL CARE FROM ANY LICENSED PHYSICIAN, HOSPITAL OR CLINIC FOR ANY INJURY OR ILLNESS THAT MAY ARISE DURING ACTIVITIES ASSOCIATED WITH Workout UNIT 64, LLC. IF I AM SIGNING ON BEHALF OF A MINOR CHILD, I ALSO GIVE FULL PERMISSION FOR ANY PERSON CONNECTED WITH Workout UNIT 64, LLC TO ADMINISTER 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.

I have read and agree.

Express Consent for Photography and Video *

EXPRESS CONSENT FOR PHOTOGRAPHY AND VIDEO PARTICIPANTS: PARTICIPANT INVOLVED IN ANY ACTIVITIES OFFERED BY Workout UNIT 64, LLC MAY BE PHOTOGRAPHED OR VIDEOTAPED DURING TRAINING. THE UNDERSIGNED HEREBY CONSENT TO THE USE OF THESE PHOTOGRAPHS AND/OR VIDEOS WITHOUT COMPENSATION, ON THE Workout UNIT 64, LLC WEBSITE OR IN ANY EDITORIAL, PROMOTIONAL OR ADVERTISING MATERIAL PRODUCED AND/OR PUBLISHED BY Workout UNIT 64, LLC.

I have read and agree.

RHABDOMYOLYSIS (“RHABDO”) RELEASE AND WAIVER *

RHABDOMYOLYSIS (“RHABDO”) RELEASE AND WAIVER: 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, extreme weakness, darkening of the urine (similar to the color of tea or cola), decreased urine output, altered mental status, and 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. 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. 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. I agree to monitor myself in a manner 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 risk that I expose myself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding activity. I for myself and on behalf of my heirs, assigns personal representative, and/or next of kin, forever WAIVE, RELEASE, DISCHARGE, and COVENANT NOT TO SUE Workout UNIT 64, LLC, and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries, participants, volunteers or assign, as well as their independent contractors.

I have read and agree.

DISCONTINUING MEMBERSHIP/PARTICIPATION *

DISCONTINUING MEMBERSHIP/PARTICIPATION: If participant discontinues their membership and continues to use the facilities and/or renews participation with Workout UNIT 64, LLC, this release will remain in full force and effect.

I have read and agree.