SIGNUP / VISIT
CrossFit Teens Punch Card
Create Account to Purchase Package
Member of CrossFit Mt Lebanon?
Purchase with your account.
-- Month --
-- Day --
--- Select Gender ---
Emergency Contact Name
Emergency Contact Phone
How did you hear about us?
Google / Web Search
Were you referred by another member?
If other, please let us know where.
Leave a short message for the gym.
Participants involved in any activities offered by CrossFit Mt. Lebanon may be photographed or videotaped during training. The undersigned hereby consents to the use of these photographs and/or videos without compensation, on the CrossFit Mt. Lebanon social media or in any editorial, promotional or advertising material produced and/or published by CrossFit Mt. Lebanon.
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). I willingly assume full responsibility for the risks that I am exposing myself to and accept full responsibility for any injury or death that may result from participation in any activity or class while at, or under direction of CrossFit Mt. Lebanon*.
I acknowledge that I have no physical impairments, injuries, or illnesses that will endanger me or others.
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 CrossFit Mt. Lebanon, I, the undersigned hereby release CF Mt. Lebanon, LLC, CrossFit Mt. Lebanon, 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, 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 CrossFit Mt. Lebanon 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 wellbeing of the child.
Rhabdomyolysis (Rhabdo) Release:
In consideration for continued access to the training facility identified herein as programming at this facility. I acknowledge and attest to having fully and carefully read and reviewed this RELEASE AND WAIVER including all subparagraphs prior to engaging in any physical activity at this facility. I, do hereby acknowledge the significant risks associated with the physical training and Rhabdomyolysis (hereinafter referred to as Rhabdo) can occur when an individual's physical activity is so intense that muscular cells begin to break down and the contents and/or remaining materials enter the bloodstream.
Rhabdo may be caused by many other systemic or environmental causes. However, Exertional Rhabdo can occur in athletes of all levels of fitness, resulting in muscle cell destruction. The skeletal muscle breakdown impairs kidney function as those organs are unable to handle increased enzymes that are released into the bloodstream. This induces severe physiological changes in the body. The symptoms of Rhabdo include muscle pain, stiffness and extreme weakness, darkening of the urine (similar to the color of tea or cola), decreased urine output, altered mental status, swelling of the body part involved, either with or without pain. A Rhabdo symptom is pain out of proportion to the amount of soreness that one would generally expect, often producing pain much quicker than one would expect after a workout.
I understand that any concerns on my part that I am experiencing any of the symptoms of Rhabdo require immediate presentation to a hospital for emergency treatment. I acknowledge that no third party, either from the facility or otherwise, will be capable of monitoring my urine output or color, and it is my responsibility to be continually cognizant of this symptom and all other symptoms and to monitor them in my own body at all times. I agree that I will remove myself from participation and seek medical treatment of my own accord should I have any concerns regarding possible symptoms of Rhabdo. I understand that statistically individuals most likely to experience Rhabdo are in good shape by general standards or who were previously in good physical shape. This includes individuals who were prior athletes. I acknowledge that often the more mentally tough an athlete is and the more athletic they were in the past or currently are, the greater the risk of exposure to Rhabdo.
I agree to monitor myself in a manner that is proportionate to the potential injury that can be occasioned by this condition. I acknowledge and understand that I am the only individual capable of determining if I am experiencing Rhabdo symptoms. I hereby agree and do willingly assume responsibility for any risks that I expose myself to and accept full responsibility for death or any injury that may result from participating in this significantly demanding physical activity
I for myself and on behalf of my heirs, assigns, personal representatives and/or next of kin, forever WAIVE, RELEASE, DISCHARGE and COVENANT NOT TO SUE and/or their officers, directors, representatives, partners, employees, subsidiaries, or assigns, as well as independent contractors.
There is a wealth of medical and popular information regarding the condition known as Rhabdomyolysis available on the internet. It is strongly recommended that you review and evaluate information from all sources available to you, including your physician, prior to executing this Release or participating in strenuous physical activity. I hereby acknowledge I fully read this document and has been given the opportunity to ask any questions that I may have regarding its contents.
: The participant recognizes that there is risk involved in the types of activities offered by CrossFit Mt. Lebanon. 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 or intentional act or omission. 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 CF Mt. Lebanon, LLC, d/b/a CrossFit Mt. Lebanon, 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 CrossFit Mt. Lebanon, at the main building or abroad. This includes but is not limited to parks, recreational areas, playgrounds, areas adjacent to main building, and/or any area selected for training by CrossFit Mt. Lebanon.
I have read and understood the foregoing assumption of risk and release of liability and I understand that signing it obligates me to indemnify the parties named for any liability for injury or death of any person and damage to property caused by my negligent or intentional act or omission. I understand that by signing this form I am waiving valuable legal rights.
Please use your mouse/finger to sign your name
Clear Member Signature
By clicking this checkbox you agree to online signature signing of this waiver
I consent to conduct electronic business
Billing First Name
Billing Last Name
Credit Card Number
Expiration Date (mm/yyyy)
You will be immediately charged $125.00*
I understand this charge and understand that there are no refunds.
Thank you for joining the CrossFit Mt Lebanon Community
427 Washington Rd
Pittsburgh, PA 15228
Triib, Inc Copyright © 2018
- All Rights Reserved
Powered by Triib, Inc