New Member Waiver & Release

Name *
Name
Address *
Address
Date of Birth *
Date of Birth
Phone *
Phone
Emergency Contact Name
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Phone
Do You Smoke?
Do You Drink?
Previous Injuries or Surgeries?
Do You Take Prescription Medication? *
Are You Currently Exercising? *
Do You Play Sports?
Do You Have: Back Pain, Neck Pain, or Shoulder Pain? *
Do You Have: High Blood Pressure, Asthma, or a Heart Condition? *
Any Other Conditions Not Listed? *
Photography/Video Release *
Participants involved in any activities offered by CrossFit Evermore may be photographed or videotaped during trained. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the CrossFit Evermore website in any editorial, promotional or advertising material produced and/or published by CrossFit Evermore.
Waiver and Release of Liability
Express assumption 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 my partner(s). I willingly assume full responsibility for the risks that I am exposing myself 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 CrossFit Evermore. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others. Release: 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 CrossFit Evermore, I, the undersigned hereby release CrossFit Evermore, their principles, agents, employees, 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 the negligent acts or omissions of the above mentioned parties. This agreement shall be binding up on 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. If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit Evermore to administer first 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. Indemnification: The participant recognizes that there is risk involved in the types of activities offered by CrossFit Evermore. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself 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.