Book a Trial

Full name

Email address

Date of birth

Phone Number

Where did you hear about Blitz?

Word of Mouth

Friend is a member

Social Media

Google

Local Business

Passing by locally

Other

Emergency contact

Full Name

Phone Number

Legal Documents

The Movement Space Ltd - Blitz // Waiver

Waiver and Release of Liability

Express assumption of risk:

I, the undersigned, am aware that there are significant risks involved in all aspects of physical training. 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, my training partner, or other people around me; injury or death due to improper use or failure of equipment; strains and sprains. I am aware that any of these above-mentioned risks may result in serious injury or death to myself and or my partner(s).

Blitz CrossFit does not exclude or limit in any way its liability to you where it would be unlawful to do so. This includes liability for death or personal injury caused by our negligence or the negligence of our employees, agents or subcontractors; for fraud or fraudulent misrepresentation; for breach of your legal rights in relation to the services. I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

We are responsible to you for foreseeable loss and damage caused by us. If we fail to comply with these terms, we are responsible for loss or damage you suffer that is a foreseeable result of our breaking this agreement or our failing to use reasonable care and skill, but we are not responsible for any loss or damage that is not foreseeable. Loss or damage is foreseeable if either it is obvious that it will happen or if, at the time the contract was made, both we and you knew it might happen, for example, if you discussed it with us during the sales process or has been set out in this form.

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 Blitz CrossFit to administer first aid deemed necessary, and in case of serious illness or injury, I give permission to call for medical and or surgical care for the child and to transport the child to a medical facility deemed necessary for the well being of the child.

Indemnification: I recognise that there is risk involved in the types of activities offered by Blitz CrossFit. Therefore I accept responsibility for any injury that the I may cause either to myself or to any other participant due to my negligence. Should Blitz CrossFit be required to incur any legal fees and costs in the event someone else brings a claim against Blitz CrossFit due to my negligence, I agree to reimburse Blitz CrossFit for such fees and costs.

Are you a parent/guardian signing on behalf of a 16-18 year old?

Yes

If you answered yes to the above please enter the parent/guardians name.

If you answered yes to the above please enter the parent/guardians contact number.

Have you done CrossFit before?

Yes

What CrossFit affiliate do you currently train at, or have trained at in the past?

How did you hear about Blitz?

What are your goals coming to Blitz?

I have read and understood the foregoing assumption of risk, and release of liability and I understand that by signing it obligates me to indemnify and reimburse Blitz CrossFit for any liability caused by my negligent or intentional act or omission.

The Movement Space Ltd - Blitz // Photography & Video Release

Photography/Video Release

Participants involved in any activities offered by Blitz CrossFit may be photographed or videotaped during training.

Please note that you may withdraw your consent at any time by contacting us at info@blitz.fit

By signing below, I hereby consent to the use of these photographs and/or videos without compensation, on the Blitz CrossFit website or in any editorial, promotional or advertising material produced and/or published by Blitz CrossFit.

The Movement Space Ltd - Blitz // PAR-Q

If you are between the ages of 15 and 69, the Par-Q will tell you if you should check with your doctor before you significantly change your physical activity patterns. If you are over 69 years of age and not used to being very active, please check with your doctor. Common sense is your best guide when answering these questions. Please read carefully and answer each one honestly.

If you answer YES to one or more of the following questions: You should consult with your doctor to clarify that it is safe for you to become physically active at this current time and in your current state of health.

If you answer NO to all of the following questions: It is reasonably safe for you to participate in physical activity, gradually building up from your current level. A fitness appraisal can help determine your ability levels.

Has your doctor every said you have a heart condition AND that you should only do physical activity recommended by a doctor?

Yes

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

Yes

In the past month, have you had a chest pain when you were not doing physical activity?

Yes

Do you lose your balance because of dizziness or do you ever lose consciousness?

Yes

Do you have a bone or joint problem (for example; back, knee or hip) that could be made worse by a chance in physical exercise?

Yes

Is your doctor currently prescribing medication for your blood pressure or heart condition?

Yes

Do you know of any other reason why you should not do physical activity?

Yes

I have read, understood and accurately completed this questionnaire. I confirm that I am voluntarily engaging in an acceptable level of exercise, and my participation involves a risk of injury.