Waiver Form Release of Liability, Waiver of Claims, Assumption of Risk BY SIGNING THIS DOCUMENT YOU WILL WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.You are advised that athletic activity and training are DANGEROUS RECREATIONAL ACTIVITIES with OBVIOUS RISKS as defined by the Civil Liability Amendment (Personal Responsibility) Act. YOU ARE PARTICIPATING AT YOUR OWN RISK. PERSONAL INFORMATIONName* First Last Email* Enter Email Confirm Email Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Mobile*Phone*Birth Date* Gender*MaleFemaleEmergency Contact Name* First Last Emergency Contact Phone*How did you hear about us?*Subscribe to our newsletters Yes, please subscribe me to your site!HEALTH ASSESSMENTHave you ever had any form of heart disease?*YesNoHave you ever experienced shortness of breath or chest pains?*YesNoDo you have a family history of heart disease?*YesNoDo you have problems with your knees?*YesNoDo you have problems with your back?*YesNoDo you have any hip/pelvis problems?*YesNoDo you have high / low blood pressure?*YesNoDo you have any neck/shoulder problems?*YesNoDo you have diabetes?*YesNoDo you have any current injuries?*YesNoDo you have any allergies?*YesNoAre you currently taking any medication?*YesNoAre you a smoker?*YesNoAre you currently exercising?*YesNoHave you participated in strenuous exercise before?*YesNoDo you ever get dizzy?*YesNoAre there any exercises that you know you cannot do?*YesNoIs there any reason you know of that you should not participate in exercise?*YesNoMore informationIf you answered yes to any of the above questions please provide more information in this space.Type your name as signature*Your ip address is recorded to confirm it is you signing.Warning…. Safety First!!High intensity training must be approached cautiously in the beginning, a gradual ramp up of intensity is necessary to allow muscles cells to adapt to the new demands placed on them. Failure to do so, opens the door to a life threatening condition, known as ‘Rhabdomyolysis’. In the short, the muscle cells are damaged flooding the blood stream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, loading to potential shut down. CrossFit can cause ‘Rhabdomyolysis’. It is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are a warning signs of ‘Rhabdo’. If you develop these symptoms, seek medical assistance IMMEDIATELY. In consideration of CrossFit Burleigh Pty Ltd allowing me to participate, I acknowledge, understand and I am aware that: *I have voluntarily chosen to participate in training activities provided by a CrossFit Burleigh Pty Ltd, trading as “CrossFit Burleigh”. I understand there are inherent risks in all aspects of physical training and I acknowledge that I have been informed of the possible strenuous nature of the training and the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack and/or death. I also acknowledge that I have been specifically warned about the medical condition “Rhabdomyolysis” and accordingly I have been advised to limit my effort in order to minimise the risks associated with this condition.Agreed*I understand that the training may involve weightlifting, gymnastic movements, strenuous bodyweight exercises and other high exertion activities, and that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my trainer. I give CrossFit Burleigh Pty Ltd and the staff of the facilities I train in permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred.Agreed*I agree to WAIVE ANY AND ALL CLAIMS that I have or may have in the future against CrossFit Burleigh Pty Ltd, and its directors, officers, employees, agents, volunteers and independent contractors (all of whom are hereinafter collectively referred to as “the Releasees”). I agree to RELEASE THE RELEASEES from any and all liability for any loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the programs, activities and services provided by CrossFit Burleigh Pty Ltd, due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care. I agree to HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by the releasees.Agreed*This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. 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. If I am signing on behalf of a minor child, I also give full permission for any person connected with CrossFit Burleigh Pty Ltd to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.Agreed*Use of picture(s)/film/likeness: I agree to allow CrossFit Burleigh Pty Ltd, its agents, officers, principals, employees and volunteers to use 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 CrossFit Burleigh Pty Ltd of this in writing.AgreedI HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT BY SIGNING THIS “INFORMED CONSENT FORM” I AM WAIVING CERTAIN LEGAL RIGHTS (INCLUDING THE RIGHT TO SUE) WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTOR, ADMINISTERS AND ASSIGNS MAY HAVE AGAINST THE RELEASEES. ANY QUESTIONS I HAD WERE ANSWERED TO MY FULL SATISFACTION. Signature of Participant*Signature of Participant:*Type your name as signature.Your ip address is recorded to confirm it is you signing.Date* Is the participant is under the age of 18*YesNoSignature of Parent or Gurdian*Signature of Parent or Guardian:*Type your name as signature.Your ip address is recorded to confirm it is you signing.Date* (Parent/Guardian) Print Name:*EmailThis field is for validation purposes and should be left unchanged.