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Motor City CrossFit

Waiver, Release And Assumption Of Risk

35977 Mound Rd

Sterling Heights MI 48310

_____________________

 

 


1. I am physically capable of participating in exercise and other programming provided by Motor City CrossFit (MCCF) and its instructors. I understand that physical exercise, including CrossFit classes, can be strenuous and I am subject to risk of serious injury and possibly death. I understand that it is my obligation and discretion to consult a medical doctor before beginning any exercise program.

I Agree

2. I agree that if I engage in any physical activity, or use any MCCF amenity on the premises or off premises, including any sponsored MCCF event, I do so ENTIRELY AT MY OWN RISK. Any recommendations for changes in diet, including the use of food supplements and/or weight reduction products are entirely my responsibility and I will undertake to consult a physician prior to undergoing any dietary or food supplement changes.

I Agree

3. I agree that MCCF is also not responsible for any loss of or damage to, personal property.

I Agree

4. I understand that the exercises provided by MCCF may be extremely demanding and I take full responsibility for knowing, monitoring and acting within my abilities and learning and incorporating any modifications or adaptations necessary to proceed with such activities in a safe and appropriate manner.

I Agree

5. I understand that in undertaking CrossFit exercises, there is a risk of rhabdomyolysis (rhabdo). Rhabdo is a potentially lethal systemic meltdown initiated by the kidneys in response to the presence of shed muscle-fiber debris and exhaust in the bloodstream. There are several causes and types of rhabdo, classified by the underlying cause of muscle breakdown, and there is a risk in CrossFit of suffering from exertion rhabdomyolysis.

I Agree

6. I agree that MCCF its directors, officers, members, employees, and contractors shall not be liable or responsible for any injuries to me which may occur as a result of: (a) my use of all amenities and equipment provided by MCCF and my participation in any activity, class, program or instruction, (b) the sudden and unforeseen malfunctioning of any equipment, (c) MCCF's instruction, training, supervision or dietary recommendations, (d) my slipping and/or falling while in the facility, or on MCCFs premises, including adjacent sidewalk, driveway and street areas and (e) any collisions with any other members or vehicles of any kind while visiting or exercising at MCCF facilities.

I Agree

7. I expressly agree that this release shall be binding upon my heirs, executors, administrators and assigns. 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 Agree

8. Use of picture(s)/film/likeness: I agree to allow Motor City Crossfit, its agents, officers, principals, employees, and volunteers the 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 Motor City Crossfit of this in writing.

I Agree

By signing this Waiver & Release, I acknowledge that I have read this release and understand all of its terms. I execute it voluntarily and with full knowledge of its significance.

 

 

First Participant's Name

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

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

First Name*

Middle Name

Last Name*

Phone*
Tenth Participant's Date of Birth*
Participant's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
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.


By signing below the Parent or Court-Appointed Legal Guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Middle Name

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Signature*
Electronic Signature Consent*
By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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