1. Name *

First Name

Last Name

4. Phone *

If 24-Hour Access is granted, please type your phone number where you will receive a text message with a code to the front door.

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6. Physical Activity Readiness Questionnaire (PARQ) *

Regular physical activity is fun and healthy, and increasingly more people are starting to become more active every day. Becoming more active is very safe for most people. However, some people should check with their doctor before they start becoming much more physically active. Please answer the Physical Activity Readiness Questionnaire (PARQ) to see if you are eligible for 24-hour access. If you answer yes to any of these questions, you must check with your doctor before continuing any physical activity. In addition, if you have answered yes to any of the questions, we will require a doctor's note clearing you for physical activity before allowing any 24-hour access. If you are over 69 years of age and you are not used to being active, check with your doctor. Please read the questions carefully and answer each one honestly. Check the box indicating yes or no.

I promise to answer each of the questions honestly.

Do you feel pain in your chest when you do physical activity? *

Yes

No

In the past month, have you had pain in your chest while NOT doing physical activity? *

Yes

No

Has your Doctor ever said that you have a heart condition and that you should only do physical activity recommended by a Doctor? *

Yes

No

Do you lose your balance due to dizziness or do you ever lose consciousness? *

Yes

No

Do you have a bone or joint problem that could be made worse by a change in your physical activity? *

Yes

No

Is your Doctor presently prescribing drugs (for example, water pills) for your blood pressure or heart condition? *

Yes

No

7. Compliance with the Rules *

Please check the boxes indicating that you understand the rules.

I understand and agree that a 24/7 gym membership is a special membership based on trust and is a privilege, which can be taken away for a violation of rules.

I understand that Open gym and 24-hour access does not mean that open gym is available 24-hours a day. Specifically if a group class is in session, my open gym is over.

As a gym member, I agree to abide by all gym membership rules and 24/7 membership rules, which will be posted at the facility, website and may be amended from time to time at the sole discretion of the gym.

I understand that 24-hour access is available for Unlimited Access athlete who have a minimum of six months’ continuous CrossFit experience.

I understand that access sharing with any client, friend, family member, etc or clients who DO NOT have 24-hour access is strictly prohibited and will result in immediate loss of membership or loss of 24-hour access; access or card-sharing is viewed by ownership as stealing services.

I understand that pre-approved 24/7 members under the age of 18 must be accompanied by an approved member parent or approved guardian member until they reach the full age of 18 years and can request access on their own.

I understand that child care is not provided during 24-hour access.

I understand that for safety reasons children are not allowed to be in the gym during 24-hour access.

I understand that for safety reasons, no kids will be allowed on the gym floor or on any equipment.

I understand that children must remain in a supervised child care room. Insurance regulations prohibit children being in the gym area or being unsupervised in the child care room.

I understand that I must wear proper exercise attire.

I understand that General warm-ups are recommended before doing a full-scale workout, metcon, or any exercises or movements. These are similar to the style of the group classes, for example, as many rounds as possible in 7 minutes of of light-weight or bodyweight movements would be a good choice.

I understand that a specific warm-up after the general warm-up is recommended to prepare for the specific movements, exercises, or workouts of my plan.

I understand that stretching and mobilization is recommended to ensure that I am flexible enough to perform desired movements, exercises, workouts.

I understand that I will limit all movements to 80% of max load during hours that aren’t staffed by a coach.

I understand that unfamiliar movements and unfamiliar exercises are not recommended without staff present.

I understand and will be considerate of others in the gym and will make sure that I have enough room to be safe during my workout, metcon, exercise, or movement.

I understand that some exercises that require a spotter (like back squats or bench presses) are not recommended; if I am alone in the gym. Be smart and safe!

I understand that CrossFit Edwardsville is not responsible for lost or stolen items that I leave at the gym. (Please double-check that you’ve collected all of your things to take with you.)

I understand that Unauthorized areas are clearly marked and secured with motion sensors during non-staffed hours. By checking this box I am indicating that I understand and will not access these areas.

8. My Promise *

Please check the boxes indicating that you will do the following things...

I promise to clean any equipment that I use once I am finished working out.

I promise to return any equipment to the proper location after use and in the same state in which I found it.

I promise to report to info@crossfitedwardsville.com if I come in contact with any equipment that is not working or usable .

I promise to make sure that the door is fully closed and locked after entry or exit of the gym.

I promise to have my cell phone on me at all times in case of an emergency.

9. No Supervision *

Please check the box indicating that you understand and acknowledge no supervision.

I understand that I am purchasing a membership at a 24/7 facility that allows access at any time. As such, I am aware that there will be no supervision or assistance except during staffed hours. Staffed hours may change at the sole discretion of the gym. I am aware that if I get injured, become unconscious, suffer a stroke or heart attack or any other medical emergency or event that there will likely be no one to respond to my emergency and that the gym has no duty to help or assistance to me while I am at the gym without supervision. I understand that even though the gym may be equipped with surveillance cameras, these records are not monitored continuously and help will not be available during non-staffed hours. However, a first aid station and AED kit are located in the facility.

10. Acknowledgement of Risk and Waiver of Liability *

Please check the box indicating your acknowledgement of risk and waiver of liability.

I voluntarily assume the risk of injury, accident, death, loss, cost or damage to my person or property which might arise from my use of the gym, and I agree to hold harmless and release the gym and all affiliated corporations, and its officers, directors, board members, agents, employees, representatives, executors, and all others from any and all liability. I also release all of those mentioned and any others acting on their behalf from any responsibility or liability for any injury or damage to myself including those caused by the negligent act or omission of any of those mentioned or others acting on their behalf or in any way arising out of or connected with my participation in any activities or the use of any equipment at the gym during staffed or non-staffed hours.

11. Informed Consent *

Please check the box indicating that you consent to the General Statement of Program Objectives and Procedures.

I understand that a physical fitness program may include exercises to build the cardio-respiratory system (heart and lungs), the musculoskeletal system (muscle endurance, strength and flexibility), and to improve body composition (decrease of body fat in individuals needing to lose fat, with an increase of muscle and bone). Exercise may include aerobic activities, calisthenics, and weight lifting to improve muscular strength and endurance, and flexibility exercises to improve joint range of motion.

12. Description of Potential Risks *

Please check the box indicating that you acknowledge and understand the potential risks.

I understand that the reaction of the heart, lung, and blood vessel system to such exercise cannot always be predicted with accuracy. I know there is a risk of certain abnormal changes occurring during or after exercise, which may include abnormalities of blood pressure or heart rate, in effect of functioning of the heart, and in rare instances heart attacks. Use of the weight lifting equipment, and engaging in heavy body calisthenics, can lead to musculoskeletal strains, pain, and injury if adequate warm-up, gradual progression, and safety procedures are not followed.

13. Cleared for Exercise *

Please check the box indicating that you have been cleared by your medical doctor for exercise.

I certify that I am in good physical health and I am able to undertake and engage in the range of physical activities in which I choose to participate at the gym. I assume all responsibility for updating the facility which respect to any changes in my physical or mental condition and for reporting all injuries sustained at the facility to the gym staff. I understand and am aware that strength, flexibility, aerobic and anaerobic exercise, including the use of any equipment, is a potentially hazardous activity. I also understand that fitness activities involve a risk of injury and even death and that I am voluntarily participating in these activities and using equipment with knowledge of all the dangers involved. I do hereby agree to expressly assume and accept any and all risks of injury or death either accidental or otherwise. This waiver, release and indemnification agreement includes, without limitation, all injuries which may occur as a result of (a) my use of all amenities and equipment in the facility and my participation in any class, activity or personal training, (b) sudden unforeseen malfunctioning of any equipment and (c) my slipping or falling while in the facility, on the facility premises, including adjacent sidewalks and parking areas. I acknowledge that I have carefully read this waiver, release and indemnification agreement and fully understand that it is a full and complete release of all liability. ­

14. Duty to Inform of Changes in Health Condition *

Please check the box indicating that you understand and acknowledge that you must inform any changes in your health conditions.

I understand that I am required to inform the gym of any material changes in my health condition in the future, including but not limited to, any changes which would cause me to change my responses to the PARQ above.

15. General *

Please check the box indicating that you acknowledge and understand this agreement between you and the gym.

This contract represents the complete understanding between you and the gym. No representations, written or oral, other than those contained in this contract are authorized or binding upon the gym. Should any part of this agreement due to legal or other regulatory changes become unenforceable, the remaining provisions within this agreement not impacted by such change shall remain in full force as originally written. You agree to promptly update the gym of any changes of address, phone, e-mail address and/or bank account/credit card information.