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STATEMENT OF MEDICAL CONDITION, ASSUMPTION OF RISK,
RELEASE AND INDEMNIFICATION
 
 
Participant. I,(The undersigned), agree to participate in one or more physical fitness programs, classes, workouts or eventssponsored or held by CrossFit Strong, LLC, which may include but does not require, and is not limited to, one or more of the following: initial assessment, introductory training, personal training and/or coaching, CrossFit training, and/or physical fitness training, and/or assistance or instruction of any kind, by CrossFit and/or any affiliate, coach, trainer, subsidiary or partnership of CrossFit Strong, LLC and/or Ashley and Gale Yocom (hereinafter collectively referred to as CrossFit Strong). Prior to participating, CrossFit Strong has made me fully aware that the fitness programs/classes which CrossFit Strong offers and in which I desire to participate are of a nature and kind that are extremely strenuous and can/may push me to the limits of my physical abilities. I recognize and understand that the programs/classes and exercises undertaken therein are not without varying degrees of risk, which may include, but are not limited to the following: muscle soreness, tearing of muscles, minor aches and pains, tiredness, stiff joints and muscles, tearing of muscles, ligament, muscle, tissue or bone tearing or breakage, serious and/or life-threatening injuries to the musculoskeletal and/or cardio respiratory systems, serious bodily injury or death.
 
I Agree
 
 
Registration Form:: Health Assessment :: Liability Waiver
 
Statement of medical condition. I realize that CrossFit Strong offers training programs that are difficult for very fit persons, including elite athletes, competitive athletes, and combat-ready troops. Knowing this to be the case, I do hereby state and certify that I receive periodic medical check-ups at least once a year, that I have had a physical examination from a competent physician within the past 12 months, and that I have no cardiovascular or other concerns, problems or illnesses that might keep me from participating in a CrossFit training program, such as (but not limited to) heart problems, lung problems, circulatory problems, diabetes, high blood pressure, low blood pressure, hardening of the arteries, shortness of breath, chest pains, arrhythmia, heart palpitations, arterial dysfunction, circulatory disorders, or other condition that would raise concern in the mind of a reasonable person. I have no knowledge of any other medical problem or condition or problem that might increase my risk of illness and injury as a result of participation in such a program. CrossFit Strong has fully and carefully informed me that I may experience adverse physical changes during and/or after exercise, such as joint or muscular aches and/or pain, swelling, abnormal blood pressure, fainting, disorder of heart rhythm, stroke, and in very rare instances, heart attack or even death, and again, I fully understand this to be the case. With my full understanding of this information, I again agree to assume any and all risk associated with my participation in CrossFit Strong fitness programs/classes.
 
I Agree
 
Assumption of All Risks. For and in consideration of being allowed to participate, I do hereby intentionally, willingly and voluntarily assume full responsibility for any and all risks of injury, including serious bodily injury or death, as stated above, to which I may be exposed as a result of my participation in CrossFit Strong physical fitness programs, classes, workouts or events. I accept full and complete responsibility for any injury or death, including expressly any injury or death that which results from my own negligence.
 
I Agree
 
Release. For and in consideration of being allowed to participate, and in recognition of the above-mentioned risks and hazards, I do hereby intentionally, willingly and voluntarily release, waive, remise and discharge CrossFit Strong, its agents, officers, principles, and employees, and each of their heirs and assigns from any and all claims and causes of action, known or unknown, including any liability, claim, demand, action or right of action arising or out of my participation in the above-referenced activities.
 
I Agree
 
Indemnification: I recognize that there is risk involved in the types of activities offered by CrossFit Strong. Therefore I accept financial responsibility for any injury that I or 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 costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless CrossFit Strong, 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 CrossFit Strong.
 
I Agree
 
Binding upon heirs and assigns; laws; venue. This release and all other terms and conditions hereof 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. This agreement shall be interpreted according to the laws of the State of Texas and venue for any litigation arising out of or relating to this documents shall be exclusively in Collin County, Texas.
 
I Agree
 
Use of picture(s)/film/likeness: I agree to allow CrossFit Strong, its agents, officers, principals, employees and volunteers to create and use picture(s), film and/or likeness of me for advertising purposes. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform CrossFit Strong of this in writing.
 
I Agree
 
Rhabdomyolysis: I have received and read the addendum Rhabdomyolysis.
 
I Agree
 
I have read the foregoing document. I understand it. I have been given a full and complete opportunity to ask any and all questions regarding it. I understand that by signing it, I am waiving and otherwise affecting my valuable legal rights. It is my intention to do so.
 
I Agree
 
FOR PARTICIPATION BY MINOR CHILD
Minor child (if applicable). I am signing the foregoing document on behalf of a minor child, whose name is undersigned,  (Names and dates of birth for additional children may be added below the signature line below.) I am the parent and/or legal guardian of the child and have authority to execute this document on behalf of the child. I also give full permission for any person connected with CrossFit Strong to administer first aid to said child, as and to the extent deemed necessary, and in case of potentially serious illness or injury, I give CrossFit Strong permission to call for medical and or surgical care for the child, and to transport and/or authorize transportation of the child to a medical facility.
 
 
 
 
Registration Form:: Health Assessment :: Liability Waiver
Addendum 
 
RHABDOMYOLYSIS 
Exertional rhabdomyolysis, or rhabdo, is muscle damage that arises from overexertion of the muscles. It can happen to anyone, but usually occurs in the untrained, or when high-heat/high-humidity conditions are present and an individual is severely dehydrated and fatigued. Some other factors that can increase the risk of developing rhabdo are: training at high altitude, repeated eccentric muscular contractions (i.e. doing "negatives"), recent viral illness, and taking cholesterol lowering drugs (i.e. statins). It can, and has, happened to military recruits, marathon runners, "weekend" workout warriors, and, yes, even experienced Trainees. It's important to understand what rhabdo is so that you can recognize it if you develop the conditions, or notice these conditions in someone else.
 
Rhabdo is much more than run-of-the-mill muscle soreness that lasts for a couple of days. In a typical case of rhabdo, the muscle pain is severe, limits your range of motion, and hits with full force about two days after a strenuous workout. Sore muscles alone are not enough to cause serious concern; however, if the soreness and pain are accompanied by extreme swelling of the affected muscles, a physician should be consulted to make sure that the condition hasn't developed into rhabdo, or, even more worrisome, compartment syndrome. If the muscle soreness and swelling are ever accompanied by dark urine, a trip to the emergency room is a must in order to avoid renal failure! A sure way to determine if one has rhabdo is to do a serum CK, or CPK, test. Normal CK levels run between 0 and 150 IU/L, but it isn't uncommon for CK levels to rise above the normal range after strenuous exercise. Documented cases of rhabdo typically result in CK levels five times above normal - some above 50,000 IU/L! Regardless, even mild increases of CK above normal could cause kidney failure. Thus the reason why rhabdo is taken so seriously. One way to help reduce the chance of rhabdo is to maintain proper hydration before, during, and after working out. Proper hydration helps flush the elevated CK and myoglobin out of the system as well as help with general improved fitness and health. We recommend drinking 60% of your body weight in ounces of water each day to maintain proper hydration, even in cold weather. 
 
Another way to avoid rhabdo is to maintain a regular High Intensity Fitness routine. Regular High Intensity Training will push out the limits where one could experience rhabdo. For someone who has been a regular Trainee of 4 to 6 times per week, rhabdo is unlikely, but it could occur if one is dehydrated or extremely fatigued. Trainees can even take a week off every three months or so without hurting performance or increasing their risk of rhabdo. For those who don't train so often, more caution should be taken with regard to strenuous workouts. And for those who are deconditioned, there must be a long on-ramp to full-blown High Intensity Fitness workouts or the risk for rhabdo is high. Trainees will experience sore muscles often. That's just part of High Intensity Training. Sometimes Trainees will even experience some slight swelling and pain in muscles and joints. Again, that's part of High Intensity and hard training. These sore muscles and minor swelling and joint pain from overexertion do not indicate rhabdo, but they could be accompanied by slightly elevated CK levels in the blood. This is normal and recovery is fairly rapid. A short rest of a couple days off, hydration, and backing off of the high intensity for a bit will aid in recovery from overexertion. Recovering from a bout of acute exertional rhabdomyolysis could take weeks or months depending upon the severity of the condition. Only your doctor can say for sure when you can start to train again. Once you're cleared to begin your training, it starts from ground zero with a long on-ramp to high intensity coupled with a lot of strength building. 
 
Work hard, but be smart. If your High Intensity Fitness trainer tells you to back off on the weight or the intensity of the workout, listen to him or her. If you're dehydrated, fatigued, or just not feeling right that day, make sure you back off on the intensity on your own. If you're taking a statin, or any other drug for that matter, make sure your trainer knows this as well. High Intensity Fitness training is hard, but it isn't intended to put you in the hospital. So train hard, but train smart! 
 
Tips to reduce likelihood of getting Rhabdo: 
- Stay Hydrated at all times 
- When starting a new exercise program, ramp up your intensity level, Don’t do too much, too soon. 
- Avoid excessive alcohol use 
- Avoid drug use (If you take Statins, let your trainer know) 
- Monitor Physical Output in Hot/Humid Environments 
 
Signs and Symptoms that you may have Rhabdo: 
- Extreme Muscle Soreness including back and abdominal pain (10 out of 10 on pain scale) 
- Muscle Swelling 
- Rosy or Coca-Cola colored urine 
- Possible Fever, Nausea, vomiting 
 
What do I do if I have these symptoms: 
- If your muscles are EXTREMELY painful to include back and abdominal pain, and / or 
- If your urine is discolored you need to seek immediate medical attention.Go to the ER and explain your recent training activity.

 

First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth
First Participant's Signature
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth
11 Participant's Name

First Name*

Last Name*
11 Participant's Date of Birth
Parent or Guardian's Email Address

Email*

Confirm Email*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
CrossFit Strong recommends that you clear your participation in any exercise program with your physician.
Are you visiting from out of town?
Health Information
Have you ever had any form of heart disease?
No
Yes

Explain:
Have you ever experienced shortness of breath or chest pains?
No
Yes

Explain:

Date of last full physical:

Do you have/do any of the following pertain to your heath?


High Blood Pressure?
No
Yes

Levels:
Cigarette Smoking?
No
Yes
Diabetes?
No
Yes

Types:
Family History of Heart Disease?
No
Yes

Who/ Age?
Do you work out at least three times per week?
No
Yes
Are you currently taking any medication?
No
Yes

Explain:

Do you have problems in the following areas?

Knees:
No
Yes

Explain:
Lower Back:
No
Yes

Explain:
Neck/Shoulders:
No
Yes

Explain:
Hip/Pelvis:
No
Yes

Explain:
Any Other?
No
Yes

Explain:
Is there any reason you know of that you should not participate in exercise?
No
Yes

Explain:
Parent(s) or Court-Appointed Legal Guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.
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Phone*
Parent or Guardian's Date of Birth
Parent or Guardian's Signature
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