The following invoice shows what you will be charged as you select classes to drop into.
*Required Fields Waiver and Release. *Name: _______________________________
Express assumption of risk: *DOB: _________________________________
I am aware that there are significant risks involved in all aspects of physical *EMAIL: _______________________________________
training. These risks include, but are not limited to: falls, which can result in serious injury or death, injury or death due to improper use or failure of *PHONE #:_____________________________
equipment. I am aware that any of the above mentioned risks, may result
in serious injury or death to myself and/or my partner(s). I affirm that I have ADDRESS: _____________________________________
read the article on rhabdomyolysis that I have been given. 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 provided by Duke City CrossFit.
I, the undersigned acknowledge that I have no physical
impairments or illnesses that will endanger myself or others.
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
provided by Duke City CrossFit, I hereby release Duke City CrossFit, 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 upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, the remainder of the agreement shall remain in full force and effect. If I am signing on behalf of a minor child, I also give full permission for Duke City CrossFit and any person connected to them, to administer first aid if 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 authorize Duke City CrossFit to take pictures and Videos of me and use them on their website and other promotional and educational materials.
I recognize that there is a risk involved in the types of activities offered by Duke City CrossFit. I therefore accept financial responsibility for any injury that I may cause either to myself or to others. 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 will reimburse them for such fees and costs. I agree to indemnify and hold harmless Duke City CrossFit, Their principles, 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 Duke City CrossFit at their main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by Duke City CrossFit.
Acceptance:Signature of Participant:
I have read and understood the foregoing and I _____________________Date: ________
understand that by signing this, it obligates me
to indemnify the parties named for any liability Signature of Parent or Guardian:
for injury or death of any person and damage to If the participant is under the age of 18