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Flaming Gorge CrossFit


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, but not limited to: 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 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 coach. I understand that the programs and classes offered by Flaming Gorge CrossFit/Powerhouse Fitness LLC are of a nature and kind that are extremely strenuous and can/may push me to the limits of my 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 myself, my training partner, or other people around me, 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 myself and or my partner(s). 


Physical Activity Readiness Questionnaire / Waiver

I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. I hereby certify that I know of no medical problems that would increase my risk of illness and injury as a result of participation in a fitness program designed by Flaming Gorge CrossFit/Powerhouse Fitness LLC. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC programs/classes. [initial]

By signing this document, I acknowledge that I have voluntarily chosen to 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, rhabdomyolosis, fainting, heart attack, or death. By signing this document, I assume all risk for my health and well- being and hold Flaming Gorge CrossFit/Powerhouse Fitness LLC, as well as its owners, employees, and other authorized agents including independent contractors, harmless therefrom. I understand that questions about exercise procedure and recommendations are encouraged and welcome.


Waiver and Release:I fully understand that my personal exercise program may be strenuous and I choose to participate voluntarily. I accept all responsibility for my health and any results, injury or mishaps that may affect my well-being or health in any way. I waive any claims, demands, causes of action or any claims for relief whatsoever against, and release Flaming Gorge CrossFit/Powerhouse Fitness LLC (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 I may have for injuries or other damages, arising out of participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC activities, including, but not limited to the personal training / nutritional programs and programs/classes. 


Photo/Video Release: I hereby grant Flaming Gorge CrossFit/Powerhouse Fitness LLC permission to use my photograph/video image in any and all publications for Flaming Gorge CrossFit/Powerhouse Fitness LLC, including web site entries, without payment or any other consideration in perpetuity. I hereby authorize Flaming Gorge CrossFit/Powerhouse Fitness LLC to edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. I 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 Flaming Gorge CrossFit/Powerhouse Fitness LLC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf of on behalf of my 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 Flaming Gorge CrossFit/Powerhouse Fitness LLC. Therefore I hereby accept full responsibility for any and all damage, injury, paralysis, or death arising out of my participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC activities, programs, or classes. I hereby agree that neither I, my family, heirs, successors, assigns, or anyone claiming any interest through me, will bring any legal action whatsoever against Flaming Gorge CrossFit/Powerhouse Fitness LLC, their principals, agents, employees, contractors, or volunteers as a result of any such damage, injury paralysis, loss, or death to myself or any other person that arises out of my participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC activities, programs, or classes. I hereby agree to hold harmless and indemnify Flaming Gorge CrossFit/Powerhouse

Fitness LLC, their principals, agents, employees, contractors, or volunteers for any and all claims, including attorneys' fees and costs, which may be brought against Flaming Gorge CrossFit/Powerhouse Fitness LLC, their principals, agents, employees, contractors, or volunteers by anyone claiming to have been injured as a result of any injury, including death, to me or my property which may occur as a result of my participation in Flaming Gorge CrossFit/Powerhouse Fitness LLC activities, programs, or classes.


Children: As a convenience to our clients, our Kids Area is available for parents/caretakers while using the facility. This area is not supervised by the staff of Powerhouse Fitness LLC (hereinafter "Flaming Gorge Crossfit”). Kids are to remain in the Kids Area during class for their own safety. Drinks without lids and food are not permitted to limit messes and respect potential food allergies of others. Please care for this area as you would your own by respecting the shared property and tidying the space upon departure. Please refrain from bringing sick children to the Kids Area.

Flaming Gorge Crossfit informed me that there is no supervision of children, other than that of the parent or legal guardian who is responsible for their own child and I fully understand the same. The Kids area is an unsupervised area that may contain toys or contain items that other children have brought along with them, if there is any risk related to these objects being around or in contact with my child I willingly take that risk. I am solely responsible for any and all items, potential food or liquids and other objects that come into contact with my child in the facility. The back rooms which includes a kitchen area and bathrooms are off limits for children without the supervision of an adult. I understand that there are inherent dangers associated with having children unsupervised in these areas and that having unsupervised children in these areas may result in a child/children being harmed.

 

I agree without reservation that I must explain to my child the rules of the gym as posted and that no children are allowed to play on the fitness equipment at any time without express gym owner permission and adult supervision. Should permission be given, I accept any risk to my child or children. I further understand that no children are allowed into any of the back rooms including bathrooms or kitchen area without being accompanied by a parent/guardian and Flaming Gorge Crossfit is not legally responsible for any harm that may occur to any minor child should any minor child be harmed while in these unauthorized areas.

 

I, the undersigned, hereby hold harmless, waive and release Flaming Gorge Crossfit, their staff, officers, representatives, agents, organizers, and successors from liability as a result of personal injury or property damage occurring while the above child/children is/are in their care at Flaming Gorge Crossfit. I willingly assume full responsibility for any and all risks that I am exposing my child or children to as a result of bringing my child or children to Flaming Gorge Crossfit and its programs/classes. I further accept full responsibility for any type of harm, injury or potential for death that may result from my child’s participation in any play activity, class or general presence in the gym environment and back rooms. I hereby certify that I know of no medical problems that would increase my child’s risk of illness and injury as a result of entry into the facility.

 

With my full understanding of the above information, I agree to assume any and all risk associated with bringing my minor, child or children along with me in my participation in Flaming Gorge Crossfit programs/classes. 


I have fully read and fully understand the foregoing assumption of risk and release of liability and I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person or damage to property caused by me. I understand that by signing this form I am waiving valuable legal rights.


I have carefully read this Agreement and fully understand its contents. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, and of my own free will.

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