*Your address will be added to our WODIFY system. You may receive correspondence from both WODIFT and Crossfit Toowoomba from time to time.

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Download "*Your address will be added to our WODIFY system. You may receive correspondence from both WODIFT and Crossfit Toowoomba from time to time."

Todd Barker
5 years ago
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Name: Date of Birth: Emergency Name and Contact No: Address: Contact Number: Email Address Occupation: Have you done Crossfit Before? Gender: If so where?

1 Name: Date of Birth: Emergency Name and Contact No: Address: Contact Number: Address Occupation: Have you done Crossfit Before? Gender: If so where? *Your address will be added to our WODIFY system. You may receive correspondence from both WODIFT and Crossfit Toowoomba from time to time. HEALTH ASSESSMENT Are you currently exercising? Have you participated in strenuous exercise before Have you consulted a doctor about starting an exercise program? Have you ever had any form of heart disease? Do you have any current injuries? Have you ever experienced shortness of breath or chest pains Do you have any allergies? Do you have a family history of heart disease? Are you currently taking any medication? Do you have problems with your knees? Do you have problems with your back? Do you have any hip/pelvis problems? Do you have any neck/shoulder problems? Do you smoke? Do you ever get dizzy? Do you have high blood pressure? Do you have low blood pressure? Are there any exercises you know you cannot do? Do you have diabetes? Is there any reason you know of that you should not participate in exercise? Do you have an infectious disease? Do you have Asthma? Are you or could you be pregnant? Do you or have you had Rheumatic or Ross River Fever? Do you have a liver or kidney condition? Do you have Arthritis? Do you have or have you had Cancer? Do you have or have you had a Thyroid Condition? Do you have Epilepsy? Do you have high cholesterol?

2 If you have answered YES to any of the questions in the Health Assessment, or have any other condition please provide more information in the space below. WARNING..Safety first!! High Intensity exercise must be approached cautiously in the beginning, a gradual ramp up of intensity is necessary to allow muscle and other cells to adapt to the new demands being placed on them. Failure to do so opens the door to a life threatening condition, known as Rhabdomyolysis, In short the muscle cells are damaged flooding the bloodstream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, leading to potential shutdown. CrossFit, as well as other forms of high intensity exercise, can cause Rhabdomyolysis. It is important that you start at a reduced intensity. Brown urine (coke coloured), complete muscle weakness and/or swelling of joints are warning signs of Rhabdo. If you develop these symptoms, seek medical assistance IMMEDIATELY I have read and understand the above information and have completed this section to the best of my knowledge. Parent or Guardian for Participants under 18 years of age

3 INFORMED CONSENT FORM WARNING: Indemnity, Waiver and Release from Liability CF Alpha Bravo Pty Ltd ACN , trading as CrossFit Toowoomba CrossFit Toowoomba provides high intensity physical fitness and health related training, programs, activities and services, including but not limited to weightlifting, gymnastic movements, strenuous bodyweight exercises and other high exertion activities. Participation in high intensity physical fitness and health related activities exposes a participant to a number of risks to health and safety, including (but not limited to) abnormal blood pressure, muscle soreness, tendon or ligament damage, fainting, dizziness, heart attack, disability and death. If you agree to participate in CrossFit Toowoomba s training, programs, activities or services, you agree to do so at your own risk. In consideration of CrossFit Toowoomba allowing me to participate in group training sessions, training, programs, activities and services, I acknowledge, understand and I am aware that: I have voluntarily chosen to participate in group training sessions, training, programs, activities and services provided by CrossFit Toowoomba at my own risk. I understand such a program can enhance the musculoskeletal and cardio respiratory systems. I also understand there are inherent risks in participating in a program of strenuous exercise. I have been informed of the possible strenuous nature of the activities and the potential for undesirable, physiological results including, but not limited to, abnormal blood pressure, muscle soreness, tendon or ligament damage, fainting, heart attack, disability and/or death. I also acknowledge I have been specifically warned about the medical condition Rhabdomyolysis and accordingly I have been advised to limit my effort in order to minimise the risks associated with this condition. I understand that participation in CrossFit Toowoomba training, programs, activities and services may involve weightlifting, gymnastic movements, strenuous bodyweight exercises and other high exertion activities, and that I am not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refuse such participation at any time during my training sessions. I understand that should I feel light-headed, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my Trainer. I give CrossFit Toowoomba and its officers, employees and contractors permission to administer first aid to me and/or seek emergency medical services for me should I become injured or ill and I agree that I am solely responsible for any expenses incurred and will pay these costs on demand. It is an individual s responsibility to ensure that he/she has adequate insurance cover for his/her needs. CrossFit Toowoomba encourages all participants to take out and maintain Private Health and Income Protection Insurance according to their own individual needs and circumstances.

4 I further acknowledge and agree that due to the nature of CrossFit Toowoomba s training, programs, activities and services, it would be unreasonable for CrossFit Toowoomba to be in any way responsible for any injury or illness to me, any damage to me or my property or my disablement or death. In this agreement: Claim means any claim, cause of action, proceeding, suit or demand against a person however it arises and whether it is present, future, fixed, unascertained, actual or contingent; and; Liability includes any loss, damage, liability, cost or expense (including legal costs on a solicitor and own client basis) however it arises and whether it is present, future, fixed, unascertained, actual or contingent. I irrevocably indemnify CrossFit Toowoomba and CrossFit Toowoomba s officers, employees, volunteers, agents and contractors (the Indemnified) against any Claim or Liability arising from or relating to: my use of CrossFit Toowoomba s facilities or equipment. I irrevocably waive any and all Claims that I have had, have now or may in the future have against the Indemnified arising from or relating to: my use of CrossFit Toowoomba s facilities or equipment I irrevocably release the Indemnified from any Claim or Liability that I may have had, have now or may in the future have against any or each of the Indemnified arising from or relating to: my use of CrossFit Toowoomba s facilities or equipment. I agree that the terms of this agreement are ongoing and will apply to all occasions I: participate in CrossFit Toowoomba s training, programs, activities or services; use CrossFit Toowoomba s facilities or equipment. This agreement shall be binding upon me, my successors, personal representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid or unenforceable, I agree that the invalid or unenforceable part may be severed and the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child or dependent (dependent), I also give CrossFit Toowoomba and its directors, employees and contractors permission to administer first aid to my dependent

5 and/or seek emergency services for my dependent should my dependent become injured or ill and I agree that I am solely responsible for any expenses incurred and will pay these costs on demand. Use of picture(s)/film/likenesses: I agree to allow CrossFit Toowoomba, their agents, officers, principals, employees and volunteers to use Picture(s), film and/or 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 Toowoomba of this in writing. I consent to CrossFit Toowoomba collecting personal information from me, including contact details so that I (or my next of kin) may be contacted where required, including in an emergency and to share information with me. I consent to giving and receiving information electronically. I HAVE READ AND UNDERSTOOD THIS AGREEMENT AND I AM AWARE THAT I AM WAIVING AND/OR GIVING UP CERTAIN LEGAL RIGHTS (INCLUDING THE RIGHT TO SUE) WHICH I OR MY SUCCESSORS, PERSONAL REPRESENTATIVES, HEIRS, NEXT OF KIN, EXECUTOR, ADMINISTERS AND ASSIGNS MAY HAVE AGAINST THE INDEMNIFIED. ANY QUESTIONS I HAD WERE ANSWERED TO MY FULL SATISFACTION. Parent or Guardian for Participants under 18 years of age

ENROLMENT FORM. Title: First Name: Surname: Postal Address: Postcode: Emergency Contact: Relationship: Phone: What is your main fitness goal?

ENROLMENT FORM. Title: First Name: Surname: Postal Address: Postcode: Emergency Contact: Relationship: Phone: What is your main fitness goal? ENROLMENT FORM Personal Information Title: First Name: Surname: Date of Birth: Sex: Female Male Postal Address: Postcode: Phone: Home: Work: Mobile: Email: Preferred method of contact: Letter Phone Email