Bluenose Fitness Waiver
ASSUMPTION OF RISK, RELEASE OF LIABILITY, WAIVER AND INDEMNITY AGREEMENT AND PHYSICAL ACTIVITY READINESS QUESTIONAIR (PAR-Q). PLEASE- READ THIS DOCUMENT CAREFULLY. BY ELECTRONICALLY SIGNING THIS DOCUMENT, YOU ARE AGREEING TO WAIVE CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE.
I acknowledge and agree that:
a) I will follow all instructions and directions (if any) that may be provided to me by CrossFit Bluenose during training programs;
b) At certain times I access CrossFit Bluenose, there may be no supervision or assistance available to me. I understand that if I am injured, become unconscious, or suffer a stroke or heart attack, there may be a delay or no one to respond to my emergency and that CrossFit Bluenose has no duty to provide any assistance to me;
c) I will provide CrossFit Bluenose with an honest and accurate description of my level of physical fitness, health, and nutrition, use of medication, medical history, and current physical, mental, and medical condition. If I answer “yes” to one or more questions on the attached PAR-Q form, I will consult with my physician prior to commencing athletic activities with CrossFit Bluenose;
d) I consent to receive first aid and medical treatment from CrossFit Bluenose in the event of an accident, injury or illness during athletic activity. If I have provided medication to CrossFit Bluenose, I consent to receive such medication and I consent to CrossFit Bluenose administering such medication to me;
e) There will be no refunds for any and all membership purchases unless special circumstances permit as decided by management;
f) CrossFit Bluenose may videotape, audiotape, or photograph me for instructional and promotional purposes without payment of any kind to me and without further notice to me or permission from me;
g) I understand that having my child(ren) present while I am using CrossFit Bluenose facility, participating in or watching CrossFit Bluenose activities, or being present on CrossFit Bluenose premises, is at my own risk, and that I am solely responsible for supervising my child(ren) during such times;
h) I understand that any memberships, agreements or contracts may be terminated at any point in time under the discretion of CrossFit Bluenose in order to uphold the integrity of the business, operations of the facility or the safety and security of staff and/or clientele.
ASSUMPTION OF RISKS
I understand that by participating in the training programs provided by CrossFit Bluenose, I will be exposed to many risks, dangers and hazards which could result in physical injury, death, damages or other losses to me. Some of these risks, dangers and hazards include, but are not limited to:
a) Health: overexertion, dehydration, fatigue, and various injuries caused by my lack of fitness or conditioning;
b) Premises: defective, dangerous or unsafe condition of the facilities; falls; collisions with objects, equipment or persons;
c) Use of Equipment: mechanical failure of the equipment; negligent design or manufacture of the equipment; the provision of or the failure by CrossFit Bluenose to provide any warnings, directions, instructions or guidance as to the use of the equipment; failure to use or operate the equipment within my own ability;
d) Advice: negligent advice regarding training programs; and
e) My conduct and the conduct of others: I understand that my negligence, and the negligence of others, including the NEGLIGENCE OF CROSSFIT BLUENOSE, may increase my risk of damage, loss, personal injury or death. I understand that CrossFit Bluenose may fail to safeguard or protect me from the risks, dangers and hazards of training programs, some of which are referred to above.
Despite the risks, dangers and hazards associated with participating in training programs, and fully understanding the nature and extent of such risks, dangers and hazards, I wish to participate in training programs with CrossFit Bluenose, and I FREELY ACCEPT AND FULLY ASSUME all such risks, dangers and hazards and the possibility of personal injury, death, property damage and loss resulting from such training programs.
RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNIFICATION
In consideration of CrossFit Bluenose allowing me to participate in training programs and to use its equipment, facilities and services, I agree that:
1. I WAIVE ANY AND ALL CLAIMS that I now have, or may in the future have, against CrossFit Bluenose AND I RELEASE CROSSFIT BLUENOSE from any and all liability for any loss, damage, expense or injury (including death) that I, or my next-of-kin, may suffer as a result of my participation in training programs, DUE TO ANY CAUSE WHATSOEVER including, but not limited to:
a) Negligence on the part of CrossFit Bluenose;
b) Breach of contract by CrossFit Bluenose;
c) Breach of warranty by CrossFit Bluenose in respect of the design, manufacture, selection, installation, maintenance or adjustment of equipment;
d) Breach of any statutory or other duty of care on the part of CrossFit Bluenose;
e) The failure by CrossFit Bluenose to safeguard or protect me from the risks associated with training programs; and
2. I WILL INDEMNIFY CROSSFIT BLUENOSE FROM, AND COMPENSATE CROSSFIT BLUENOSE FOR, any and all liability that CrossFit Bluenose may incur for any damage, loss, expense or injury to any third party resulting from my participation in training programs. In the event that I die or become unable to make my own decisions, I agree that this Agreement will remain binding upon my heirs, next-of-kin, executors, administrators, assigns and representatives (collectively, my “Heirs”). Definition of INDEMNIFICTION: to compensate someone for harm or loss; to secure someone against legal responsibility for their actions.
INSURANCE: I understand that CrossFit Bluenose does not provide me with any disability, accident, liability or medical insurance or compensation in the event that I become injured or cause personal injury or property damage to any third party while participating in training programs.
JURISDICTION: This Agreement and any rights, duties and obligations as between CrossFit Bluenose and I shall be governed by and interpreted solely in accordance with Nova Scotia law. Any litigation involving CrossFit Bluenose and I must be brought solely within Nova Scotia and shall be within the exclusive jurisdiction of the Courts of Nova Scotia.
I acknowledge that, in entering into this Agreement I am not relying on any oral or written representations or statements made by CrossFit Bluenose with respect to the safety of training programs other than what is set forth in this Agreement. Within reason, civil mediation will take place before any attempts of legal proceedings.
I understand that in this Agreement, the following terms have the following meanings:
a) “CrossFit Bluenose” is operating under the registered business name “CrossFit Bluenose Inc.”, and includes its directors, owners, employees, independent contractors, trainers, instructors, agents, volunteers, servants, representatives, successors and assigns; and
b) “training programs” includes all activities, programs, events, classes, and services provided, sponsored or organized by CrossFit Bluenose including, but not limited to: fitness classes; personal training; weight training; sporting events; use of strength training and fitness conditioning equipment, machines and facilities; nutritional and dietary programs; health, wellness and fitness assessments; orientation or instructional sessions or lessons; and all other such related activities.
PHYSICAL ACTIVITY READINESS QUESTIONAIR (PAR-Q): Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Being more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active.
If you are planning to become much more physically active than you are now, start by answering the seven questions in the box below. If you are over 69 years of age, and you are not used to being very active, check with your doctor. Common sense is your best guide when you answer these questions. Please read the questions below carefully and answer honestly.
1. Has your doctor ever said that you have a heart condition and that you should only do physical activity recommended by a doctor?
2. Do you feel pain in your chest when you do physical activity?
3. In the past month, have you had chest pain when you were not doing physical activity?
4. Do you lose your balance because of dizziness or do you ever lose consciousness?
5. Do you have a bone or joint problem (for example, neck, shoulder, back, knee or hip) that could be made worse by a change in your physical activity?
6. Is your doctor currently prescribing drugs (for example, water pills) for your blood pressure, cholesterol or heart condition?
7. Do you know of any other reason why you should not do physical activity?
If you answered YES to one or more of the questions: Talk to your doctor by phone or in person BEFORE you start becoming more physically active. Tell your doctor about the PAR-Q and which questions you answered YES. You may be able to do any activity you want – as long as you start slowly and build up gradually. Or, you may need to restrict your activities to those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. (MB)
If you answered NO honestly to all PAR-Q questions: You can reasonably sure that you can start becoming more physically active- begin slowly and build up gradually. This is the safest and easiest way to go. Delay becoming more active if you are not feeling well because of a temporary illness such as a cold or fever- wait until you feel better. If you are or may be pregnant, talk to your doctor before you start becoming more active. Please note: if your health changes so that you then answer YES to any of the above questions, tell your fitness or health professional. Ask whether you should change your physical activity plan. (MB)
TO BE COMPLETED BY PARTICIPANT OR LEGAL GUARDIAN OF PARTICIPANT IF PARTICIPANT IS UNDER THE AGE OF 18:
I have read and understood this agreement, and I UNDERSTAND THAT BY ELECTRONICALLY SIGNING THIS AGREEMENT I AM WAIVING CERTAIN LEGAL RIGHTS WHICH I OR MY HEIRS MAY HAVE AGAINST CROSSFIT BLUENOSE.
Signature ______________________________ Date__________