Waiver

Filling out this waiver online will save some valuable time at your first class. Valuable time for what, you ask? Well getting to meet the great people at 12 Gauge of course!


CrossFit 12 Gauge recommends that you clear your participation in any CrossFit program with your physician.

I have applied to CrossFit 12 Gauge’s CrossFit based exercise training program (the “program”) at CrossFit 12 Gauge’s facility located at 3321 Dill Smith Dr. Fredericksburg VA, 22408.

I hereby acknowledge that I should consult with my physician before beginning any exercise program.

I certify that I am not aware of any medical conditions which would render me unfit to participate in any exercise program and that I will inform CrossFit 12Gauge immediately of any change in my medical condition.

I authorize any representative of CrossFit 12Gauge to obtain emergency medical treatment for me, including transportation to a hospital or other medical facility.

For valuable consideration received, I grant to CrossFit 12 Gauge and any hired photographer ("12 Gauge") the absolute and irrevocable right and unrestricted permission concerning any photographs that are taken or may take of me (or child (CrossFit Kids)) or in which I (or child) may be included with others, to use, reuse, publish, and republish the photographs in whole or in part, individually or in connection with other material, in any and all media now or hereafter known, including the internet, and for any purpose whatsoever, specifically including illustration, promotion, art, editorial, advertising, and trade, without restriction as to alteration; and to use my name in connection with any use if they so chooses. I release and discharge 12 Gauge from any and all claims and demands that may arise out of or in connection with the use of the photographs, including without limitation any and all claims for libel or violation of any right of publicity or privacy. This authorization and release shall also inure to the benefit of the heirs, legal representatives, licensees, and assigns of 12 Gauge.

I UNDERSTAND AND ACKNOWLEDGE THAT THERE ARE RISKS INHERENT IN ANY EXERCISE PROGRAM INCLUDING BUT NOT LIMITED TO HEART ATTACK, STROKE, ORTHOPEDIC INJURY, INJURIES CAUSED BY THE USE OF EXERCISE EQUIPMENT AND OTHERS.  THESE INJURIES CAN OCCUR SUDDENLY AND WITHOUT WARNING, AND MAY RESULT IN DEATH. I AM VOLUNTARILY PARTICIPATING IN THIS TRAINING PROGRAM WITH KNOWLEDGE OF THE DANGERS INVOLVED, AND I HEREBY AGREE TO ACCEPT ANY AND ALL RISKS OF INJURY OR DEATH, AND VERIFY THIS STATEMENT BY PLACING MY INITIALS ABOVE.

FOR AND IN CONSIDERATION OF PERMITTING ME TO PARTICIPATE IN THE PROGRAM, I, FOR MYSELF AND FOR MY HEIRS, BENEFICIARIES, AND PERSONAL REPRESENTATIVE, HEREBY RELEASE AND FOREVER DISCHARGE CROSSFIT 12GAUGE AND ITS DIRECTORS, OFFICERS, MEMBERS, MANAGERS, EMPLOYEES, AGENTS, ATTORNEYS, INSURERS, SUCCESSORS, AND ASSIGNS (COLLECTIVELY, “CROSSFIT 12GAUGE PARTIES”), FOR ANY AND ALL CLAIMS, DEMANDS, DAMAGES, LOSSES, LIABILITIES, RIGHTS, ACTIONS, CAUSES OF ACTION, EXPENSES, AND SUITS OF ANY KIND WHATSOEVER, FORESEEN OR UNFORESEEN, FOR PERSONAL INJURY, WRONGFUL DEATH, DAMAGE TO PROPERTY, OR OTHERWISE RESULTING FROM MY PARTICIPATION IN THE PROGRAM AND/OR THE ACTS OF OMISSIONS OF ANY OF CROSSFIT 12GAUGE PARTIES, INCLUDING ANY AND ALL NEGLIGENT ACTS, WHETHER ACTIVE OR PASSIVE, IRRESPECTIVE OR WHETHER SUCH INJURIES, DEATH OR DAMAGES OCCUR DURING TRAINING OR THEREAFTER.

24/7 Program Access Assumption of Risk:
CrossFit 12 Gauge (“12 Gauge”) STRONGLY RECOMMENDS THAT YOU CLEAR YOUR PARTICIPATION IN ANY EXERCISE PROGRAM WITH YOUR PHYSICIAN. USE OF THE CrossFit 12 Gauge FACILITIES UNDER THE 24/7 ACCESS PROGRAM IS UNMONITORED, AND YOUR USE OF THE 12 Gauge EQUIPMENT AND FACILITIES IS AT YOUR OWN RISK – 12 Gauge WILL NOT BE RESPONSIBLE OR LIABLE FOR ANY INJURY OR DAMAGES INCURRED BY YOU ARISING OR CONNECTED IN ANY WAY WITH YOUR USE OF THE 12 Gauge EQUIPMENT AND FACILITIES. MEMBERSHIP IS AT 12 Gauge's SOLE DISCRETION AND ANY VIOLATION OF THE RULES AND REGULATIONS CAN RESULT IN CANCELLATION OF MEMBERSHIP.

I AM AT LEAST 18 YEARS OF AGE. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME AND CROSSFIT 12GAUGE AND I SIGN IT ON MY OWN FREE WILL.

 
Completing this waiver verifies that you have carefully read the above agreement and understand its contents.
Name *
Name
Phone *
Phone
Minor's Name (CrossFit Kids)
Minor's Name (CrossFit Kids)
Address *
Address
Emergency Contact *
Emergency Contact
Emergency Contact Phone *
Emergency Contact Phone
Date *
Date