CrossFit Kids Winter Break Camp
1 Attendance Package
5 day winter break camp Jan 1-5 10:30-11:15
* plus any applicable taxes
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I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Mountain Loop CrossFit Inc. 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 herby 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 Mountain Loop CrossFit; With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Mountain Loop CrossFit Inc. programs/classes.
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, rhabdomyolosis, fainting, heart attack, or death. By signing this document, I assume all risk for my health and well-being and hold Mountain Loop CrossFit Inc., 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.
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 Mountain Loop CrossFit Inc. (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 for injuries or other damages, arising out of participation in Mountain Loop CrossFit Inc. activities, including, but not limited to the personal training / nutritional programs and programs/classes.
I hereby grant Mountain Loop CrossFit Inc. permission to use my photograph/video image in any and all publications for CrossFit or Mountain Loop CrossFit Inc., including web site entries, without payment or any other consideration in perpetuity. I hereby authorize Mountain Loop CrossFit Inc. to record, edit, alter, copy, exhibit, publish or distribute collectively, 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 and forever discharge Mountain Loop CrossFit Inc. from all claims, demands, and causes of 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 such Use or this authorization.
I recognize that there is risk involved in the types of activities offered by Mountain Loop CrossFit Inc. 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& or fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless Mountain Loop CrossFit Inc., 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 Mountain Loop CrossFit Inc.
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.
Please answer the following questions:
Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
Do you feel pain in your chest when you do physical activity?
In the past month, have you had chest pain when you were not doing physical activity?
Do you lose your balance because of dizziness or do you ever lose consciousness?
Do you have a bone or joint problem (for example, neck, shoulder, back, knee or hip) that could be made worse by a change in your physical activity
Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure, cholesterol or heart condition?
Do you know of any other reason why you should not do physical activity?
Upon purchasing a membership package there is a 30 day cancellation policy due in writing and emailed to firstname.lastname@example.org. By clicking Yes you agree to these terms.
By clicking this checkbox you agree to online signature signing of this waiver
I consent to conduct electronic business
Member/Adult Signuture (Must be over 18 to sign)
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You will be immediately charged $45*
I understand this charge and understand that there are no refunds.
Thank you for joining the Mountain Loop CrossFit Community
* plus any applicable taxes