Name *

First Name

Last Name

Date of birth *

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

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Health Declaration *

By entering CrossFit Knoxfield I agree that - I will comply with any relevant DHHS advice and guidelines - I have not come into contact with anyone recently diagnosed wth COVID - I do not have any flu-like symptoms - Myself or any household members are not awaiting a COVID test result

I agree

Waiver *

Please read the waiver below. I grant permission of CrossFit Knoxfield and any other authorities to take pictures and videos of me and use them on their website and other promotional and educational materials without compensation to me. I am aware that there are significant risks involved in all aspects of CrossFit. 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, 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 might result in serious injury or death to me. I affirm I’m fully aware of the risks of rhabdomyolysis and will seek medical attention immediately if I experience symptoms of severe cramping, darkened urine. 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 or attendance at CrossFit Knoxfield. I recognise that there is risk involved in the activities offered at CrossFit Knoxfield. I accept financial responsibility for any injury that I may cause either to myself or to others. 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 will reimburse them for such fees and costs. I agree to indemnify and hold harmless CrossFit Knoxfield, their principals, 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, WARNING UNDER THE AUSTRALIAN CONSUMER LAW AND FAIR TRADING ACT 2012 Under the Australian Consumer Law (Victoria), several statutory guarantees apply to the supply of certain goods and services. These guarantees mean that the supplier named on this form is required to ensure that the recreational services it supplies to you; *are rendered with due care and skill; and *are reasonably fit for any purpose which you, either expressly or by implication, make known to the supplier; and *might reasonably be expected to achieve any result you have made known to the supplier. Under section 22 of the Australian Consumer Law and Fair Trading Act 2012, the supplier is entitled to ask you to agree that these statutory guarantees do not apply to you. If you sign this form, you will be agreeing that your rights to sue the supplier under the Australian Consumer Law and Fair Trading Act 2012 if you are killed or injured because the services provided were not in accordance with these guarantees, are excluded, restricted or modified in the way set out in this form.

I agree