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    Waiver

    CFRI & Raw Iron Health Assessment & Waiver/Release of Liability

    PRE-ACTIVITY QUESTIONNAIRE

    In preparation for physical activity, please tell us about ALL of your existing medical and physical conditions, and who to contact in an emergency. It is your responsibility to complete this form before participating in any physical activity. For any conditions that can be affected by exercise, you may be asked to consult your doctor and obtain a written medical clearance to exercise. Please give this clearance to your Coach. The information contained will be treated as confidential and only revealed to relevant team players (staff) for your safety.

    Please note that it is your responsibility to inform us of any changes in your medical or physical condition during your Training in/with this facility.

      YOUR INFORMATION

      EMERGENCY CONTACT

      DO YOU HAVE, OR HAVE YOU HAD, ANY OF THE FOLLOWING CONDITIONS?

      Arthritis

      Heart problems/disease

      Asthma

      High cholesterol

      Diabetes

      Stroke

      Epilepsy

      Family history of heart disease or stroke

      Osteoporosis

      High or low blood pressure

      Dizziness

      Chest pain

      DO YOU HAVE, OR HAVE YOU HAD, ANY JOINT PROBLEMS, PAINS OR INJURIES IN ANY OF THE FOLLOWING REGIONS?

      Ankles/feet

      Shoulders

      Muscular Pain

      Knees

      Neck

      Hips/pelvis

      Elbows

      Lower Back

      Wrists

      ARE YOU CURRENTLY TAKING ANY MEDICATION

      ARE YOU, OR HAVE YOU RECENTLY BEEN PREGNANT?

      ARE YOU CURRENTLY EXERCISING?

      How many times per week?

      HAVE YOU IN THE PAST?

      WARNING – SAFETY FIRST!!

      High intensity exercise must be approached cautiously in the beginning, a gradual ramp up of intensity is necessary to allow muscle cell 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 can cause Rhabdomyolysis. It is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are warning signs of “Rhabdo”. If you develop these symptons, seek medical Assistance Immediately.

      I understand that I may participate in physical activities which may expose me to certain risks and that I do so at my own risk. I will not hold Raw Iron/CFRI, or any of its servants and agents, liable for any injury, loss, damage or death caused to me or my property whether by negligence, omission, and breach of contract or in any way whatsoever.

      I undertake to complete a new preactivity questionnaire in the event of any change in my medical status during the course. I understand that it is my responsibility to advise Raw Iron of any medical/physical conditions that may prevent me from exercising, and that I participate in exercise at my own risk.

      Waiver and Release of Liability

      Raw Iron & CFRI, 38 Commercial Dr, Ashmore, QLD 4214. In consideration of Raw Iron and its trainers allowing me to participate, I acknowledge, understand and I am aware that: I have voluntarily chosen to participate in training activities provided by Raw Iron and its Trainers.

      I understand there are inherent risks in all aspects of physical training and I acknowledge that I have been informed of the possible strenuous nature of the training and the potential for undesirable physiological results including, but not limited to, abnormal blood pressure, muscle soreness, fainting, heart attack and/or death. I also acknowledge that 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 training may involve weightlifting, gymnastics movements, strenuous bodyweight exercises and other high exertion activities, and that im not obligated to perform nor participate in any activity that I do not wish to do, and that it is my right to refusesuch participation at any time during my training sessions. I understand that should i feel lightheaded, faint, dizzy, nauseated, or experience pain or discomfort, I am to stop the activity and inform my trainer. I give any Raw Iron Staff of the facilities I train in permission to seek emergency medical services for me should I become injured or ill with the understanding that I am responsible for any expenses incurred.

      I agree to WAIVE ANY AND ALL CLAIMS that I have or may have in the future against Raw Iron Directors, officers, employees, agents, volunteers and independent contractors (all of whom are hereinafter collectively revered to as “the Releasees”). I agree to RELEASE THE RELEASEES from – Any and all liability for loss, damage, injury or expense that I may suffer, or that my next of kin may suffer as a result of my participation in the programs, activities and services provided by Raw Iron, and its trainers due to any cause whatsoever including negligence, breach of contract, or breach of any statutory or other duty of care. I agree to HOLD HARMLESS AND INDEMNIFY THE RELEASEES from – Any and all liability for any damage to the property of, or personal injury to, any third party, resulting from my participation in any program, activity or service provided by the releases.

      This agreement shall be binding upon me, my successors, representatives, heirs, executors, assigns, or transferees. If any portion of this agreement is held invalid, I agree that the remainder of the agreement shall remain in full legal force and effect. If I am signing on behalf of a minor child, I also give full permission for any person connected with Raw Iron and its trainers to administer First Aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

      Use of picture(s)/Film, likeness: I agree to allow Raw Iron, its agents, officers, Principals, Employees and volunteers to use picture(s), film and/or likeness of me for advertising purposes/social media. In the event I choose not to allow the use of the same for said purpose, I agree that I must inform Raw Iron of this in writing.

      I have read and understood this agreement and I am aware that by signing this “informed consent form” I am waiving certain legal rights (including the right to sue) which I or my heirs, next of kin, executor, administrators and assigns may have against the releases. ANY QUESTIONS I HAD WERE ANSWERED TO MY FULL SATISFACTION.

      Please Sign:

      Signature of Parent or Guardian:

      (If the participant is under the age of 18)

      ENQUIRE NOW

      Enquire Now

      Fill out the form below and we will get back to you as soon as we can.


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