Name:_____________________________________________________________________________________Date of Birth:_______________

Address_____________________________________________________________________________________________________________________________________________________

Phone #_(____)______________________________________________________________________________________________________________________________________________

Email address:_____________________________________________________________________________________________________________________________________________

In case of emergency, I would like CrossFit to call:__________________________________________________________________________________________________

Phone #_(____)________________________________________This person is my: (parent, friend, spouse, ect.):___________________________________________

May we add you to our e-mail list to keep you updated on nutrition, fitness, and events?(YES/NO)

WAIVER AND RELEASE OF LIABILITY

North Haven CrossFit

88 Leonardo Dr

North Haven, CT 06473

Express assumption of risk: I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. 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).

I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at CrossFit North Haven. I, the undersigned acknowledge that I have no physical impairments or illness that will endanger myself or others.

Initials:______________________________

Use of picture(s)/films/likeness: I agree to allow CrossFit North Haven, its agents, officers, principals, employees and volunteers to use picture(s), film and/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 North Haven of this in writing.

Initials:______________________________

Release:   In consideration of the above mentioned risk and hazards and in consideration of the fact that I am willing and voluntarily participating in the activities available at CrossFit North Haven, I, the undersigned hereby release CrossFit North Haven, their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties.

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 North Haven 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.

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by CrossFit. Therefore the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. Should the above mentioned parties, or anyone acting of their behalf, be required to incur attorney’s fees and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless CrossFit, North Haven their principals, agent, from my negligent or intentional act or omission while participating in activities offered by CrossFit.

I have read and understand the foregoing assumption or risk, and release of liability and I understand that by signing it obligates me to indemnify the parties names 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.

Signature of participant___________________________________________________________________________________________________________Date_________________

If the participant is under the age of 18,

Signature of Parent or Guardian: ________________________________________________________________________________________________Date_________________

(Parent/Guardian) Print Name____________________________________________________________________________________________________________________________