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CANCER SMASH-Fitness for a Cause

Thank you for helping a great cause.  Have fun!

 

Consent, Waiver, Release, Hold Harmless and Indemnity Agreement

I/We, the undersigned(s), for and in consideration of providing the above referenced Participant with the opportunity to participate in the Flagler College PRSSA & DRiV Fitness"Cancer Smash" event at DRiV Fitness, do hereby unconditionally release, remise, acquit, discharge and waive any and all claims, from all, and all manner of actions, cause and causes of action, negligence, suits, demands, damages, and claims whatsoever, in law or in equity, which the undersigned(s), their guardian(s), personal representatives, successors, heirs or assigns ever had, now have, or hereinafter can, shall, or may have, against DRiV FiTNESS and CrossFit DF, or Drive Gym, LLC, (hereinafter collectively referred to as the Gym) Flagler College,as well as any entity or individual, coach, trainer, volunteer, employee, independent contractor or other person employed by or associated with any of the foregoing entities or programs.

I/We, the undersigned, also agree to indemnify and hold harmless the Gym and Flagler College from any and all claims for damages or other relief including, but not limited to, personal injury, death, property damage or any type of claim or damage (including, but not limited to attorneys fees and litigation expenses at trial and any appeal) resulting from or arising out of the undersigneds participation in or association with the "Cancer Smash" event, DRiV FiTNESS and CrossFit DF programing, training, classes or other events, and any damages that may be occasioned or suffered as a result of conditions of the property, equipment, or any other cause or conditional whatsoever.

The undersigned represent that the Participant is physically and mentally capable and prepared to participate in the activities offered, and that the undersigned all understand and accept the fact that sports including, but not limited to, aerobics, gymnastic, weight-lifting and fitness training involve inherent risk of injury or worse, which risks the undersigned understand and do hereby voluntarily and knowingly assume and hold the Gym harmless.

I/We, the undersigned, have read the provisions of this Consent, Waiver, Release, Hold Harmless and Indemnity Agreement and we either understand it, or have been given the opportunity to ask questions regarding it, so that we are fully informed and understand its contents prior to signing below. I/We understand that the terms of this Agreement are legally binding and that I/we effectively waive certain rights that I/we may have under applicable law.

If the Participant is under the age of majority or is otherwise unable to form the capacity to contract, then by signing below the Participants Parent or Legal Guardian do hereby consent to the Participants participation and bind themselves, as well as the Participant, to all of the terms of this Consent, Waiver, Release, Hold Harmless and Indemnity Agreement.

By signing, the undersigned does consent to grant the Gym the irrevocable license to use the participants likeness or photograph in advertisements and in other manners that may promote the Gyms business, in the exercise of the Gyms sole and ultimate discretion.

RHABDOMYOLYSIS (RHABDO)
RELEASE AND WAIVER

I do hereby acknowledge the significant risks associated with the physical training and programing at this facility. I acknowledge and attest to having fully and carefully read and reviewed this RELEASE AND WAIVER including all subparagraphs prior to engaging in any physical activity at this facility.

Rhabdomyolysis (hereinafter referred to as Rhabdo) can occur when an individuals physical activity is so intense that muscular cells begin to breakdown and the contents and/or remaining materials enter the bloodstream. Rhabdo may be caused by many other systemic or environmental causes. However, Exertional Rhabdo can occur in athletes of all levels of fitness, resulting in muscle cell destruction. The skeletal muscle breakdown impairs kidney function as those organs are unable to handle increased enzymes that are released into the bloodstream. This induces severe physiological changes in the body.

The symptoms of Rhabdo include muscle pain, stiffness and extreme weakness, darkening of the urine (similar to the color of tea or cola), decreased urine output, altered mental status, swelling of the body part involved, either with or without pain.

I understand and have been advised that generally the pain that is referred to as a Rhabdo symptom is pain out of proportion to the amount of soreness that one would generally expect, often producing pain much quicker than one would expect after a workout.

I understand that any concerns on my part that I am experiencing any of the symptoms of Rhabdo require immediate presentation to a hospital for emergency treatment. I acknowledge that no third party, either from the facility or otherwise, will be capable of monitoring my urine output or color, and it is my responsibility to be continually cognizant of this symptom and all other symptoms and to monitor them in my own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of Rhabdo.

I acknowledge and understand that all individuals engaged in demanding workouts are potentially exposing themselves to Rhabdo or other injuries/negative physical results. However, I understand that statistically individuals most likely to experience Rhabdo are those who are in good shape by general standards or who were previously in good physical shape. This includes individuals who were prior athletes and/or prior military personnel, law enforcement or firefighters. I acknowledge that often the more mentally tough a potential athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo.

I acknowledge and fully understand that statistically the chances of me developing Rhabdo are extremely slight, but I likewise appreciate the necessity that I be aware of the symptoms of this condition. I agree to monitor myself in a manner that is proportionate to the potential injury that can be occasioned by this condition. I acknowledge and understand that I am the only individual capable of determining if I am experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose myself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding physical activity.

With the opportunity to fully inform myself about Rhabdo and the risks thereof, I knowingly and freely assume and accept all such risks both known and unknown. I assume full responsibility and all risks from my participation in any physical activity at the facility. I for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE DriveGym LLC, DRiV FiTNESS, CrossFit DF, Flagler College and/or their officers, directors, representatives,partners, officials, principals, agents or employees, subsidiaries, or assigns, as well as their independent contractors.


Electronic signatures are considered, for all intents and purposes, as originals.

By signing below on this date of April 24, 2024, I/We acknowledge and agree to the terms of this agreement.

First Participants Name

First Name*

Last Name*

Phone*
First Participants Date of Birth*
First Participants Information
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First Participants Signature*
Second Participants Name

First Name*

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Second Participants Date of Birth*
Second Participants Information
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Third Participants Name

First Name*

Last Name*
Third Participants Date of Birth*
Third Participants Information
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Fourth Participants Name

First Name*

Last Name*
Fourth Participants Date of Birth*
Fourth Participants Information
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Fifth Participants Name

First Name*

Last Name*
Fifth Participants Date of Birth*
Fifth Participants Information
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Sixth Participants Name

First Name*

Last Name*
Sixth Participants Date of Birth*
Sixth Participants Information
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Seventh Participants Name

First Name*

Last Name*
Seventh Participants Date of Birth*
Seventh Participants Information
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Eighth Participants Name

First Name*

Last Name*
Eighth Participants Date of Birth*
Eighth Participants Information
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Ninth Participants Name

First Name*

Last Name*
Ninth Participants Date of Birth*
Ninth Participants Information
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Tenth Participants Name

First Name*

Last Name*
Tenth Participants Date of Birth*
Tenth Participants Information
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Parent or Guardian's Email Address

Email
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A signed copy of this waiver will be sent to the email address you provide.
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*

Last Name*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information
Shirt Size (FREE to first 50 to sign up!)*
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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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