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Waiver Consent Form

PLEASE NOTE: This waiver of Liability, Release, Acknowledgement of Risk and Indemnification Agreement (“Waiver Agreement”) is intended to be and is legally binding. If any aspect of this Waiver Agreement requires clarification, have a CrossFit Flora employee fully explain it before signing. By signing the CrossFit Flora “Student Registration” you are agreeing to all terms set forth in this Waiver Agreement. You and/or the person on whose behalf you are signing, are waiving the right to bring any type of action, whether in court or otherwise, to recover compensation or obtain any other remedy for any personal injuries, damages to property, any accident or incident of any type or death, arising out of or related to your use of CrossFit Flora, its facilities, grounds, climbing walls, exercise areas, classes, equipment, whether the use is supervised or unsupervised. While CrossFit Flora offers these activities in a controlled environment, there is still an assumed risk of injury to persons using CrossFit Flora. In agreeing to this Waiver Agreement, I hereby acknowledge, understand, and agree on my behalf, and upon behalf of the person for whom I am signing, that the use of CrossFit Flora, its facilities, equipment, climbing walls, classes and/or participating in activities sponsored by CrossFit Flora have inherent risks. These risks include, but are not limited to, any injury of damage resulting from: Negligence of employees, volunteer assistants, independent contractors of CrossFit Flora. Negligent misuse of the facility, climbing walls, or equipment of CrossFit Flora; falling off or impacting against the climbing walls, impact surface, floors or anything else; rope abrasion, entanglement or other activities occurring on the premises; cuts or abrasions resulting from any cause whatsoever; failure of the climbing walls or equipment, whether inside or outside; personal health problems, whether mental or physical; negligence of other climbers; visitors, or observers or persons who may be present in or around the climbing area or facility; and/or negligence or lack of adequate training of any person(s) who seek to assist with medical or other help either before or after any injury or damage may occur.

In consideration of being allowed to participate in the activities and programs of CrossFit Flora and to use its facilities, equipment and machinery in addition to the payment of any fee or charge, I, for myself, my heirs and assigns, hereby waive, release and forever discharge CrossFit Flora and their officers, agents, employees, representatives, executors and all others form any and all, responsibilities or liability from injuries or damages resulting from machinery in the above mentioned activities. I do hereby release all of those mentioned and any others acting upon their behalf from any responsibility or liability for any injury of those mentioned or others acting on their behalf from any responsibility or liability for any injury or damage to myself, including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities of CrossFit Flora or the use of any equipment at CrossFit Flora.


I understand and am aware that fitness and climbing, including the use of the equipment, are all potentially hazardous activities. I also understand that fitness activities involve a risk of injury or even death, and that I am voluntarily participating in these activities and using equipment and machinery with knowledge of the dangers involved. I hereby to expressly assume and accept any and all risks of injury or death.


I do hereby declare myself to be physically sound and suffering from no condition, impairment, disease, infirmity or other illness that would prevent my participation or use of equipment, climbing wall or machinery except as herein stated. I acknowledge that I have either had a physical examination and been given my physician’s permission to participate, or that I have decided to participate, in the activity of fitness and climbing and the use of the equipment, climbing wall and machinery without the approval of my physician and do hereby assume all responsibility for my participation and activities and utilization of equipment and machinery in my activities.


In consideration of having CrossFit Flora allow my child who is under the age of 18 to participate in the activities and programs of CrossFit Flora; I hereby for my child’s heirs, executors, administrators and or assigns waive and release any CrossFit Flora licensees and cooperating entities, their representatives, heirs, executors, administrators, successors and assigns for and against any and all injuries or damages or any nature my child may suffer while taking part in any activities connected with CrossFit Flora. This release and consent shall be binding upon my child’s heirs, executors, administrators and/or assigns.


In consideration for continued access to the training facility identified herein as CrossFit Flora, do hereby acknowledge the significant risks associated with the physical training and programming at this facility. I acknowledge and attest to having fully and carefully read and reviewed this “RELEASE AND WAIVER” including all subparagraphs prior to engaging in any physical activity at this facility. Rhabdomyolysis (hereinafter referred to as “Rhabdo”) can occur when an individual’s physical activity is so intense that muscular cells begin to breakdown and the contents and/or remaining materials enter the bloodstream. Rhabdo may be caused by many other systemic or environmental causes. However, Exertional Rhabdo can occur in athletes of all levels of fitness, resulting in muscle cell destruction. The skeletal muscle breakdown impairs kidney function as those organs are unable to handle increased enzymes that are released into the bloodstream. This induces severe physiological changes in the body. The symptoms of Rhabdo include muscle pain, stiffness and extreme weakness, darkening of the urine (similar to the color of tea or cola), decreased urine output, altered mental status, swelling of the body part involved, either with or without pain. A Rhabdo symptom is pain out of proportion to the amount of soreness that one would generally expect, often producing pain much quicker than one would expect after a workout.

I understand that any concerns on my part that I am experiencing any of the symptoms of Rhabdo require immediate presentation to a hospital for emergency treatment. I acknowledge that no third party, either from the facility or otherwise, will be capable of monitoring my urine output or color, and it is my responsibility to be continually cognizant of this symptom and all other symptoms and to monitor them in my own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of Rhabdo. I understand that statistically individuals most likely to experience Rhabdo are those who are in good shape by general standards or who were previously in good physical shape. This includes individuals who were prior athletes. I acknowledge that often the more mentally tough an athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo. I agree to monitor myself in a manner that is proportionate to the potential injury that can be occasioned by this condition. I acknowledge and understand that I am the only individual capable of determining if I am experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose myself to and accept full responsibility for any injury or death that may result from participating in this significantly demanding physical activity. I for myself and on behalf of my heirs, assigns, personal representatives and/ or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE Crossfit Flora and/or their officers, directors, representatives, partners, officials, principals, agents or employees, subsidiaries or assigns, as well as their independent contractors.


I willingly assume full responsibility for any and all risks that I am exposing my child or minor (under age 18) to as a result of bringing my child or children to CrossFit Flora facilities 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 or general presence in the gym environment. 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 CrossFit Flora gym facilities. CrossFit Flora 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 CrossFit Flora. I agree without reservation that I must explain to my child the rules of the gym and that no children are allowed to play on the equipment at any time without express gym owner permission and adult supervision. Should permission be given I further accept any risk to my child or children. 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 CrossFit Flora’s programs/classes.


Rules and Policy for minors (under age 18) in the gym: I agree to the following rules that apply to children who are present at CrossFit Flora. Kids area is an unsupervised area, parents are responsible for their own child, minor, or children. It is the parent’s responsibility to explain the rules to their own child, minor, or children. ALL minors MUST remain and wait in the kids area during class. This is for their OWN safety! Parents MUST CLEAN UP after their child upon exiting the gym. Please do not leave any toys or play items at the gym! Bring them home with you. Please keep food and drinks out of the gym area out of respect to risk of food allergies as well as to limit messes. NO throwing of ANY objects. NO entering the gym flooring without a parent or coaches attention. This is for their OWN safety! NO fighting! NO destructive behavior! Kids must respect other kids and listen to coaches and parents! We ask that all parents and kids/minors must know that other coaches and parents are at liberty to take charge of unruly rugrats and head off potential injuries, tantrums or general meltdowns!

    *By filling out this form, I acknowledge that I have read the above statement and agree to adhere to Flora Fit's gym policies

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