Do you smoke? Yes No
Do you drink alcohol? Yes No
Do you take prescription Medication? Yes No
Are you exercising now? Yes No
How much per week?
Do you play sports? Yes No
What Kind?
Do you have back pain, knee pain or shoulder pain? Yes No
Please explain:
Do you have high blood pressure, Asthma, Diabetes or a Heart Condition? Yes No
Do you have previous injuries or surgeries? Yes No
Please explain:
Is there any reason you know of that you should not participate in exercise? Yes No

Please list any health concerns below:

What brought you here? How did you find us?

What is your immediate Fitness Goal?

PLEASE INITIAL BELOW

Your initial below represents each check in the checkboxes


PLEASE CHECK BOX ON EACH OF THE FOLLOWING BELOW TO ACKNOWLEDGE THAT YOU UNDERSTAND AND ACCEPT EACH OF THE LISTED POLICIES

Photography & Video Release

Participants involved in any activities offered by xFitFitx, Inc. (DBA, OPTIMUM CrossFit) may be photographed or videotaped during training. The undersigned consents to the use of these photographs and/or videos without compensation, on the xFitFitx, Inc. (DBA, OPTIMUM CrossFit) website or in any editorial, promotional or advertising material produced and/or published by xFitFitx, Inc. (DBA,OPTIMUM CrossFit).

Personal Property

I agree that I am responsible for the security and safety of my own property and any personal effects I use, bring to or leave at the premise and that xFitFitx, Inc. (DBA, OPTIMUM CrossFit) cannot guaranty the security or safety of my property. Should I leave any property or otherwise in the custody of xFitFitx, Inc. (DBA, OPTIMUM CrossFit), I do so at my sole and absolute risk. xFitFitx, Inc. (DBA,OPTIMUM CrossFit) shall not have any liability to me or anyone else in the event of loss, damage, destruction or use, whether authorized or not, by any person or theft of any such property.

Surveillance

I understand that a 24-hour surveillance system is set-up for my protection, the protection of those being trained & staff at this facility. At any time, this may be reviewed to protect both parties if deemed necessary.

Discipline

Because of the nature of the workouts at OPTIMUM CrossFit, it is imperative that all members follow the advice of the staff for both their safety and the safety of the other members of the gym. OPTIMUM CrossFit reserves the right to terminate your membership in the gym at any time if the staff feels that you are a danger to yourself or others.

Guest

I assume all risk of damage or injury to any individuals that I invite as guests at OPTIMUM CrossFit, whether I am present or not, and indemnify the Released Parties against any claims for damages or injury suffered by my invited guests.

Waiver and Release of Liability

Express assumption or 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 the negligence on the part of myself. my training partner, coaches, staff or other people around me; injury or death due to improper use or failure of equipment; over-exertion, slip and fall by client, or an unknown health problem of client. I am aware that any of these above mentioned risks may result in serious injury or death to myself and/or my partner(s). I further understand that failure to execute the movements I will be taught could result in injury and that it is incumbent I use good body mechanics as instructed in order to mitigate these risks. I willingly assume full responsibility for the risks that I exposing myself to and accept full responsibility for any injury or death that may result from participating in any activity or class while at, or under direction of xFitFitx, Inc. (DBA, OPTIMUM CrossFit).

I affirm that I am capable of participating in the physical activities. I agree to assume all risk and responsibilities for exceeding my physical limits.

I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.

Release: In consideration of the above mentioned risks and hazards and in consideration of the fact that I am willingly and voluntarily participating in the activities offered by xFitFitx, Inc. (DBA, OPTIMUM CrossFit), I, the undersigned hereby release xFitFitx, Inc. (DBA, OPTIMUM CrossFit), their principals, agents, employees, and volunteers from any and all liability, claims, demands, actions or rights of action, which are related to, arise out of, or are in any way connected with my participation in this activity, including those allegedly attributed to the negligent acts or omissions of the above mentioned parties. This agreement shall be binding upon me, my successors. representative, 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.

In the event of an emergency I give permission to obtain medical assistance at a cost to myself (client only) and to request that my contact person be notified as soon as possible.

Indemnification: The participant recognizes that there is risk involved in the types of activities offered by xFitFitx, Inc. (DBA, OPTMUM CrossFit). Therefore, the participant accepts financial responsibility for any injury that the participant may cause either to him/herself or to any other participant due to his/her negligence. 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 agree to reimburse them for such fees and costs. I further agree to indemnify and hold harmless xFitFitx, Inc. (DBA, OPTIMUM CrossFit), their principals, agents, 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 in activities offered by xFitFilx, Inc. (DBA, OPTIMUM CrossFit), at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to the main building, and/or any area selected for training by xFitFitx, Inc. (DBA, OPTIMUM CrossFit).

I expressly waive the provisions and protections of Section 1542 of the California Civil Code and any similar law of any jurisdiction. I understand that Section 1542 provides as follows:
A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.
I expressly acknowledge and understand the significance, effects and consequence of a waiver of Section 1542 and hereby assume full responsibility for such a waiver.

Promise not to Bring Suit: I hereby agree and covenant not to, and shall cause the Releasors not to, bring a claim against, sue, demand compensation from or attach the property or assets of xFitFitx, Inc. (DBA, OPTIMUM CrossFit) or any of them, for any loss or damage arising or resulting from my participation in the CrossFit Class or my travel to or from or presence at OPTIMUM CrossFit, and forever release and discharge xFitFitx, Inc. (DBA, OPTIMUM CrossFit) from liability under such claims.

California Law, Jurisdiction. This Agreement shall be governed by and construed under the laws of the State of California, notwithstanding its conflict of law provisions. Any action or proceeding brought to enforce the terms of this Agreement or adjudicate any dispute arising out of this Agreement shall be exclusively brought in the County of Orange, State of California. The parties will not raise in connection therewith, and hereby waive, any defenses based upon venue, the inconvenience of the forum, the lack of personal jurisdiction, the sufficiency of service of process or the like in any such action, suit or proceeding brought in the State of California. This Agreement fully. completely, and exclusively sets forth my agreement with the Released Parties on the matters set forth herein and may only be amended in a writing executed by both the Released Parties and myself.
I UNDERSTAND THAT THE TERMS OF THIS ASSUMPTION OF RISK; WAIVER; AND LIABILITY RELEASE MEAN THAT I AM WAIVING CERTAIN IMPORTANT RIGHTS THAT I MIGHT OTHERWISE HAVE UNDER CALIFORNIA LAW.

Severability. In the event that any provision of this Agreement (or portion thereof) is determined by a court of competent jurisdiction to be invalid or otherwise unenforceable, such provision (or part thereof) shall be enforced or, if incapable of such enforcement, shall be deemed to be deleted from this Agreement, while the remainder of this Agreement shall continue in full force and remain in effect according to its stated terms and conditions.

I UNDERSTAND AND ACKNOWLEDGE THAT BY SIGNING THIS AGREEMENT, I AM GIVING UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO RECOVER DAMAGES IN CASE OF INJURY, DEATH OR PROPERTY LOSS OR DAMAGE. I UNDERSTAND THAT THIS DOCUMENT IS A PROMISE NOT TO SUE AND A RELEASE OF AND INDEMNIFICATION FOR ALL CLAIMS.

I HAVE READ THIS ENTIRE AGREEMENT CAREFULLY AND FULLY UNDERSTAND ALL OF ITS TERMS AND CONDITIONS: MY INITIALS ON THESE PAGES AND MY SIGNATURE BELOW IS MY ACKNOWLEDGMENT AND AGREEMENT THAT I HAVE HAD AN OPPORTUNITY TO CAREFULLY READ THE ENTIRE AGREEMENT AND . TO HAVE ANY QUESTIONS ANSWERED TO MY SATISFACTION.

I have read this Assumption of Risk; Waiver; and Liability Release and agree to its terms. I understand that by signing this form I am waiving valuable legal rights.



My Signature:
Date: 12-10-2018

QUESTIONAIRE

Please select your answer:

How many classes/Sessions would you like to attend per week? 1 2 3 4 5 5+

What times do you prefer to attend the classes/sessions? 6am    7am    8am    10am    noon    4:30pm    5:30pm    6:30pm    7:30pm   

Rank your goals from exercise using 1-5 scale (1=not important and 5=very important).

  • Improve cardiovascular fitness

    1 2 3 4 5
  • Loose weight

    1 2 3 4 5
  • Gain muscle

    1 2 3 4 5
  • Improve performance in another sport

    1 2 3 4 5
  • Improve flexibility

    1 2 3 4 5
  • Increase strength

    1 2 3 4 5
  • Increase energy level

    1 2 3 4 5
  • Train to compete

    1 2 3 4 5

HOUSE RULES

  • Don't be late. If you're on time, you're late. Plan to be early to class in order to sign-in, look over the WOD, and warm-up prior to starting. A good rule of thumb is to be at the box 10 minutes prior to go time.
  • We provide the very best equipment and is VERY expensive- please treat it as such. Dropping weight should be done as a last resort for safety, not to show off or to make your life easier. If you're in control of the weight (and you should be), then you shouldn't have to drop it very often. There's absolutely no excuse for dropping (or even worse...slinging) a dumbbell, kettlebell or any equipment.
  • Leave your ego at home. You know the CrossFit mantra, "Our warm-up is your workout"? It works both ways. Someone, somewhere is warming-up with your PR.
  • Your mother does not work here. Clean up your stuff. We have equipment racks. Use them. Don't leave your stuff lying on the floor. If you sweat, bleed, or puke, it's your responsibility to clean it up. We want everyone to have an enjoyable experience at OPTIMUM CrossFit and to take ownership, responsibility, and pride in the box.
  • We can't fix it if we don't know. Bring things to our attention that need fixed or don't work to improve your CrossFit experience.
  • Work hard. Put forth an effort. Don't half-ass a WOD when you know you can perform better just to boost your score or reps. Go heavy when you can but always use proper form. Jump higher. Run faster. Remove "I can't" from your vocabulary. You can and you will.
  • Etiquette. Leave any kind of negative attitude at the door. Have fun, push yourself out of your comfort zone, and cheer on your comrades. Help create a community you would love to be with.
  • Do not cheat. You're an adult and you should be able to count. Your times and reps are for yourself. Use proper logging to help yourself to improve. No one cares what your time was or how many reps you got if they were false. Earn respect. Why cheat yourself. We're all just happy that you're here and pushing yourself to reach your goal.
  • Let the coaches coach. They're certified, trained and professional. Don't give unsolicited advice. If you want to coach, get certified.
  • Listen to your body. Tell your coach immediately if you're feeling dizzy, lightheaded, or nauseous. We can help.
  • Track your progress. Record your WOD and/or lift results into the WodTogether system as soon as possible. How will you ever know you're getting better if you don't? You can't manage what you don't measure.
  • Be consistent. Work on your goals.
  • Have Fun, be part of our community and reach your fitness goals.