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CrossFit Kids Waiver / Emergency Contact & Photo Release

INFORMED CONSENT/ASSUMPTION OF RISK

I am aware that there are significant risks involved in all aspects of physical training. I understand that the reaction of the heart, lungs and vascular system to exercise cannot always be predicted with accuracy. I understand that there is a risk of certain abnormal changes occurring during or following exercise which may include abnormalities of blood pressure or heart rate; chest, arm or leg discomfort; transient light-headedness or fainting; and in rare instances, heart attack, stroke or even death. Excessive work can result (in rare cases) in injury to muscle (exertional rhabdomyolosis). I should look for signs of excessive soreness, darkened urine, and pain in the kidney areas in the days following a particularly intense workout. While this type of injury is relatively rare, it can occur due to a number of factors, including (but not limited to) genetic predisposition or dehydration, that may be beyond the control of my child’s coach or trainer. I understand that the programs and classes offered by The Pack CrossFit are of a nature and kind that are extremely strenuous and can/may push my child to the limits of his/her physical abilities. These risks include, but are not limited to: falls which can result in serious injury or death, injury or death due to negligence on the part of my child, my child’s training partner, or other people around him/her, injury or death due to improper use or failure of equipment. I am aware that any of these above mentioned risks may result in serious injury or death to my child.  I consent to my child’s participation in The Pack CrossFit’s programs/classes.  I knowingly and willingly assume full responsibility for any and all risks to which I am exposing my child as a result of his/her participation in The Pack CrossFit programs/classes and accept full responsibility for any injury or death that may result from his/her participation in any activity, class or physical fitness program. I hereby certify that I know of no medical conditions or problems that would increase my child’s risk of illness and injury as a result of participation in a fitness program designed by The Pack CrossFit. With my full understanding of the above information, I knowingly and voluntarily agree to assume any and all risk associated with my child’s participation in The Pack CrossFit programs/classes. By signing this document, I acknowledge that I have voluntarily chosen to have my child 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, injury to muscle (rhabdomyolosis), fainting, heart attack, or death. By signing this document, I assume all risk for my child’s health and well-being and hold harmless therefrom The Pack CrossFit, as well as its owners, employees, and other authorized agents including independent contractors. I understand that questions about exercise procedure and recommendations are encouraged and welcome.

Waiver and Release:

I fully understand that my child’s personal exercise program may be strenuous and I knowingly and voluntarily choose to have my child participate. I accept all responsibility for my child’s health and any results, injury or mishaps that may affect his/her well-being or health in any way. I knowingly and voluntarily waive any claims, demands, causes of action or any claims for relief whatsoever against, and release The Pack CrossFit (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 my child and we as the child’s parents have or may have for injuries or other damages, arising out of participation in The Pack CrossFit activities, including, but not limited to the personal training/nutritional programs and programs/classes.

Photo/Video Release:

I hereby grant The Pack CrossFit permission in perpetuity to use my child’s photograph/video image in any and all publications for CrossFit or The Pack CrossFit, including web site entries, without payment or any other consideration. I hereby authorize The Pack CrossFit to edit, alter, copy, exhibit, publish or distribute all photos and images. I knowingly and voluntarily waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s photo appears. Additionally, I knowingly and voluntarily 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 The Pack CrossFit from all claims, demands, and causes of action which my child or we as child’s parents and our respective heirs, representatives, executors, administrators, or any other persons acting on our, as parents, and, my child’s behalf, and on behalf of any such estate which may have or may have by reason of this authorization.

Indemnification:

I recognize that there is risk involved in the types of activities offered by The Pack CrossFit. Therefore I accept financial responsibility for any injury that I or my child may cause either to himself/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 the agreements herein, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless The Pack CrossFit, 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 or my child’s negligent or intentional act or omission while participating in activities offered by The Pack CrossFit.

I have fully read and fully understand this foregoing assumption of risk and release of liability, and I understand that signing it obligates me to indemnify the parties named for any liability for injury or death of any person and/or damage to property caused by me or my child’s negligent or intentional act or omission. I understand that by signing this form, I am waiving valuable legal rights and I may have this foregoing assumption of risk and release of liability reviewed by legal counsel of my own choice before signing it. I have carefully read this foregoing assumption of risk and release of liability and fully understand its contents. I am aware that this is a release and waiver of liability and sign it knowingly, and voluntarily, as the parents, on behalf, of my below named minor child/children.
 

Dated: April 25, 2024

First Participant's Name

First Name*

Last Name*
First Participant's Date of Birth*
First Participant's Information

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
First Participant's Signature*
Second Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Third Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Fourth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Fifth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Sixth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Seventh Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Eighth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Ninth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
Tenth Participant's Name

First Name*

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

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
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*
Phone Numbers

Home Phone

Alternate phone (parent/guardian's cell)
The following people have my consent to pick up my child from The Pack CrossFit:

Name/Cell phone

Name/Cell phone

Name/Cell phone
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*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Physician's name *

Date of last physical

1. List all current medications (Medicine / Dosage / Reason)

2. Has your child ever been restricted from physical activity for medical reasons? Please explain
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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