Waiver and release of liability I agree to the terms below.In consideration of the risk of injury while participating in (the "Activity offered by FITAGON LLC or through FITAGON LLC"), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge FITAGON LLC DBA CROSSFIT SILVERBACK, located at 17134 Stuebner Airline Rd., Spring, TX, 77379, their affiliates, managers, coaches, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I AM VOLUNTARILY PARTICIPATING IN THE AFOREMENTIONED ACTIVITY AND I AM PARTICIPATING IN THE ACTIVITY ENTIRELY AT MY OWN RISK. I AM AWARE OF THE RISKS ASSOCIATED WITH TRAVELING TO AND FROM AS WELL AS PARTICIPATING IN THIS ACTIVITY, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, PHYSICAL OR PSYCHOLOGICAL INJURY, PAIN, SUFFERING, ILLNESS, DISFIGUREMENT, TEMPORARY OR PERMANENT DISABILITY (INCLUDING PARALYSIS), ECONOMIC OR EMOTIONAL LOSS, AND DEATH. I UNDERSTAND THAT THESE INJURIES OR OUTCOMES MAY ARISE FROM MY OWN OR OTHERS' NEGLIGENCE, CONDITIONS RELATED TO TRAVEL, OR THE CONDITION OF THE ACTIVITY LOCATION(S). NONETHELESS, I ASSUME ALL RELATED RISKS, BOTH KNOWN OR UNKNOWN TO ME, OF MY PARTICIPATION IN THIS ACTIVITY, INCLUDING TRAVEL TO, FROM AND DURING THIS ACTIVITY. I agree to indemnify and hold harmless against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or my child’s negligent or intentional act or omission including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If incurs any of these types of expenses, I agree to reimburse FITAGON LLC. I acknowledge that and their directors, officers, members, coaches, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of FITAGON LLC.I acknowledge that this Activity may involve a test of a person's physical and mental limits and may carry with it the potential for death, serious injury, and property loss. The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event. To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of FITAGON LLC, its agents, and employees. I recognize that there is risk involved in the types of activities offered by FITAGON LLC. Therefore I accept financial responsibility for any injury that I or my child may cause either to himself/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 and costs to enforce this agreement, I agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless FITAGON LLC, their principals, agents, employees, and volunteers from liability for the injury or death of any person(s) and damage to property that may result from my or my child’s negligent or intentional act or omission while articipating in activities offered by FITAGON LLC. I willingly assume full responsibility for any and all risks to which I am exposing my child as a result of his/her participation in FITAGON LLC programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. 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 participation in a fitness program designed by FITAGON LLC. With my full understanding of the above information, I agree to assume any and all risk associated with my child’s participation in FITAGON LLC programs/classes. By signing this document, I acknowledge that I have voluntarily chosen to participate in a program of progressive, physical exercise. By signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including, but not limited to, abnormal blood pressure, rhabdomyolosis, fainting, heart attack, or death. By signing this document, I assume all risk for my child’s health and well-being and hold harmless therefrom FITAGON LLC, as well as its owners, employees, and other authorized agents including independent contractors. I understand that questions about exercise procedure and recommendations are encouraged and welcome. I fully understand that my child’s personal exercise program may be strenuous and I choose to have my child participate voluntarily. I accept all responsibility for my child’s health and any results, injury or mishaps that may affect his/her well-being or health in any way. I waive any claims, demands, causes of action or any claims for relief whatsoever against, and release FITAGON LLC (as well as any of its owners, employees, or other authorized agents, including independent contractors) from any and all liability, claims and/or causes of action that I may have for injuries or other damages, arising out of participation in FITAGON LLC activities, including, but not limited to the personal training/nutritional programs and programs/classes. Participants involved in the Activity offered at or through FITAGON LLC may be photographed or videotaped. The undersigned hereby acknowledges consent and no compensation is due from FITAGON LLC for editorial, promotional or published material by FITAGON LLC. I hereby grant FITAGON LLC permission in perpetuity to use my child’s photograph/video image in any and all publications for CrossFit or FITAGON LLC, including web site entries or social media, without payment or any other consideration. I hereby authorize FITAGON LLC to edit, alter, copy, exhibit, publish or distribute all photos and images. I waive the right to inspect or approve the finished product, including written or electronic copy, wherein my child’s photo appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of the photograph or video images. I hereby hold harmless and release and forever discharge FITAGON LLC from all claims, demands, and causes of action which I, my heirs, representatives, executors, administrators, or any other persons acting on my behalf, my child’s behalf, or on behalf of my estate which may have or may have by reason of this authorization. I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY AND PHOTOGRAPHY/VIDEO RELEASE FORM. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS AGENTS, ATTORNEYS, COACHES, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES: PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT-THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST FOR PERSONAL INJURY OR PROPERTY DAMAGE. Parent/Guardian Name* First Last Parent/Guardian Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Parent/Guardian Email* Parent/Guardian contact phone number*Child #1Child #1 Name*Child #1 Date of Birth* MM slash DD slash YYYY Child #1 HobbiesWhat school does your athlete attend (Child #1)?Any important information you would like me to know about your athlete (child #1)?Child #2 (optional)Child #2 NameChild #2 Date of Birth MM slash DD slash YYYY Child #2 HobbiesWhat school does your athlete attend (Child #2)?Any important information you would like me to know about your athlete (child #2)?Child #3 (optional)Child #3 NameChild #3 Date of Birth MM slash DD slash YYYY Child #3 HobbiesWhat school does your athlete attend (Child #3)?Any important information you would like me to know about your athlete (child #3)?Risks Involved I understand and agreeI fully understand that my child’s personal exercise program may be strenuous and I choose to have my child participate voluntarily. I accept all responsibility for my child’s health and any results, injury or mishaps that may affect his/her well-being or health in any way.Date* MM slash DD slash YYYY Signature*By submitting this form you agree to use electronic records and signatures.
