CHALK DIRTY CROSSFIT
2326 HIBISCUS DR- EDGEWATER- FLORIDA-32141
Physical Activity Readiness Waiver
The Physical Activity Readiness Waiver is between CF CHALK UP, LLC aka Chalk Dirty CrossFit and you, the ATHLETE (individually, if you are the ATHLETE, and/or as agents or guardian of the ATHLETE).
Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19:The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. COVID-19 is an extremely contagious disease that can lead to severe illness and death. According to the Centers for Disease Control and Prevention, senior citizens and guests with underlying medical conditions are especially vulnerable. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people. CF CHALK UP, LLC has put in place preventative measures to reduce the spread of COVID-19; however, CF CHALK UP, LLC cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending CF CHALK UP, LLC could increase your risk and your child(ren)’s risk of contracting COVID-19.
By visiting CF CHALK UP, LLC; I voluntarily assume all risks related to exposure to COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending CF CHALK UP, LLC and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the CF CHALK UP, LLC may result from the actions, omissions, or negligence of myself and others, including, but not limited to, CF CHALK UP, LLC employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the CF CHALK UP, LLC. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless CF CHALK UP. LLC employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the gym, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any CF CHALK UP,LLC program.
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 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. This type of injury 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 trainer. I understand that the programs and classes offered by CF CHALK UP, 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 injuries or death due to strenuous activity, 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).
Informed Consent / Waiver: I willingly assume full responsibility for any and all risks that I am exposing myself to as a result of my participation in CF CHALK UP, LLC activities, including, but not limited to the personal training/nutritional programs and 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 programs/classes designed by CF CHALK UP, LLC. With my full understanding of the above information, I agree to assume any and all risk associated with my participation in CF CHALK UP, LLC programs/classes. By signing this document, I acknowledge that I have voluntarily chosen to participate in CF CHALK UP, LLC activities, including, but not limited to the personal training / nutritional programs and programs/classes consisting of progressive, physical exercise. By signing this document, I acknowledge being informed of the strenuous nature of the activities/programs/classes and the potential for 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 CF CHALK UP, 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.
Emergency Medical Treatment: In case of emergency, I hereby grant permission to CF CHALK UP, LLC to notify the local Emergency Department to provide urgent medical treatment for myself. I agree to assume liability for any and all medical costs incurred as a result of my participation in the Course that are not covered by my insurance, including but not limited to costs of: medical care and treatment, ambulance services, hospital stays, and physician and pharmaceutical goods and services. I agree to indemnify and hold harmless CF CHALK UP, LLC (as well as any of its owners, employees, or other authorized agents, including independent contractors) from all liability for such costs.
Photo/Video Release: I hereby grant CF CHALK UP, LLC permission to use my photograph/video image for any legitimate purpose, without payment or any other consideration in perpetuity. I hereby authorize CF CHALK UP, LLC to record, edit, alter, copy, exhibit, publish or distribute collectively, “Use” all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I understand that all photos and images become the sole property of CF CHALK UP, LLC. I hereby hold harmless and release and forever discharge CF CHALK UP, 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 such Use or this authorization.
Indemnification:This document is a legal binding contract which supersedes any other agreements or representations by or between the parties and is intended to provide a comprehensive and complete release of liability, but is not intended to assert any claims or defenses which are prohibited by law.
I hereby agree to indemnify, defend, and hold harmless CF CHALK UP, LLC (as well as any of its owners, employees, or other authorized agents, including independent contractors) from any and all expenses incurred and claims made that relate to my participation in CF CHALK UP, LLC activities, including, but not limited to the personal training / nutritional programs and programs/classes. I hereby agree to indemnify, defend, and hold harmless CF CHALK UP, LLC (as well as any of its owners, employees, or other authorized agents, including independent contractors) from any and all expenses incurred and all claims made by myself or others (including but not limited to court costs, attorneys’ fees and litigation expenses) that arise out of or result directly or indirectly from my participation in CF CHALK UP, LLC activities, including, but not limited to the personal training / nutritional programs and programs/classes, my failure to follow any rules or directions, and/or any of my actions or inactions which cause injury or damage to myself or any other person or property.
I understand that this agreement to indemnify, defend and hold harmless operates for myself as well as on behalf of my spouse, children, parents, guardians, heirs, next of kin and any legal or personal representatives, executors, administrators, successors and assigns, or anyone else who might claim or sue on my behalf.
Florida Law Applies: I agree that the Florida law will apply to all matters relating to this Waiver. I agree that exclusive jurisdiction for any dispute with CF CHALK UP, LLC resides in the courts of the State of Florida with mandatory venue in Volusia County and expressly consent to the exercise of personal jurisdiction in the State of Florida in connection with any dispute.
Broad Interpretation: I understand and agree that this Waiver is intended to be as broad and inclusive as is permitted by the State of Florida, and that if any provision shall be found to be unlawful, void, or for any reason unenforceable, then that provision shall be severed from this Waiver and does not affect the validity and enforceability of any remaining provisions.
I have carefully read this Waiver and fully understand its contents. I understand that by signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights. I am aware that this is a release and waiver of liability and sign it knowingly, voluntarily, and of my own free will.
Signature of Participant: ___________________________ Date:______________
Under the Age of 18: Signature of Parent/Guardian: _______________________________________ Printed Name: _______________________________________