Activity Readiness Questionnaire/Waiver
Activity Readiness Questionnaire - If you answered YES to any of these questions please see us!
COMPELLED STRONGLY RECOMMENDS THAT YOU CLEAR YOUR PARTICIPATION IN
ANY EXERCISE PROGRAM WITH YOUR PHYSICIAN. THE PROTOCOLS OF THIS
PROGRAM WILL INVOLVE YOU IN RELATIVELY HIGH INTENSITY WORKOUTS AND IT
IS IMPORTANT YOU UNDERSTAND THE FOLLOWING:
I agree to participate in physical
training sessions instructed by CrossFit Level One trainers Ryan
Phelps, Becky Phelps and/or Allen Wasinger, or trainers affiliated
with CrossFit Compelled. I
am fully aware these fitness sessions are of a nature and kind that
are extremely strenuous and will push me to the limits of my physical
recognize and understand these training sessions are not without
varying degrees of risk, which may include, but are not limited to
the following: Injury to the musculoskeletal and/or cardio
respiratory systems, 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, or injury or death due to a medical
condition, whether known or unknown by me.
willingly assume full responsibility for any and all risks that I am
exposing myself to as a result of my participation in this CrossFit
training program and accept full responsibility for any injury or
death that may result from my participation.
hereby certify that I know of no medical problems that would increase
my risk of illness and injury as a result of participation in a
fitness program designed by CrossFit Compelled. I understand there
exists the possibility of adverse physical changes during an exercise
program. I fully understand that these changes could include abnormal
blood pressure, fainting, disorder of heart rhythm, stroke, and in
very rare instances, heart attack or even death. I understand that
certain prescribed medications may exacerbate these physiological
changes and create an even greater risk of physical damage or death.
With my full understanding of the above information, I agree to
assume any and all risks associated with my participation in this
CrossFit Fitness Program.
full consideration of the above mentioned risks and hazards and in
full consideration of the fact that I am willingly and voluntarily
participating in the activities made available by CrossFit Compelled,
and with my full understanding of all of the above, I hereby waive,
release, remise and discharge Ryan Phelps, Becky Phelps and Allen
Wasinger, B.A.R. 54 Fitness, LLC dba CrossFit Compelled, its agents,
partners, employees and volunteers, of any and all liability, claims,
demands, action or rights of actions, or damages of any kind related
to, arising from, or in any way connected with, my participation in
the CrossFit conditioning program.
agreement shall be binding upon me, my successors, representatives,
heirs, executers, 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.
I am signing on behalf of a minor child, I also give permission to
administer the necessary first aid, 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 medical facility deemed
necessary for the well being of the child.
there is risk involved in the types of activities offered by
CrossFit. Therefore, I accept financial responsibility for any injury
that I or 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 on their behalf, be required to
incur attorney’s fees costs to enforce this agreement, I agree to
reimburse them for such fees and costs. I further agree to indemnify
and hold harmless Ryan Phelps, Becky Phelps and Allen Wasinger,
B.A.R. 54 Fitness, LLC dba CrossFit Compelled, their partners,
agents, employees, and volunteers from liability for the injury or
death of any person(s) and damage to property that may result from my
negligent or intentional act or omission while participating in
activities offered by CrossFit Compelled.
have fully read and fully understand the foregoing assumption of
risk, and release of liability and 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.
understand that membership and prepaid sessions are not transferable.
on occasion, be photographed during training at CrossFit Compelled or
with Trainers, Ryan Phelps, Becky Phelps and/or Allen Wasinger. The
undersigned hereby consents to the use of these photographs, without
compensation, on the CrossFit Compelled web site and/or in any
editorial or promotional material produced and/or published by
consideration for continued access to the training facility
identified herein as CrossFit Compelled, 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.
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.
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
and/or their officers, directors, representatives, partners,
officials, principals, agents or employees, subsidiaries, or
assigns, as well as their independent contractors.
I hereby acknowledge that I have witnessed that the above party
has fully read this document and has been given the opportunity to
ask any questions that he/she may have regarding its contents.