Birthday Party Waiver
Parent’s Information
Child’s Information
Additional Child’s Birthday
Yes!
Waiver- PARTICIPANT AGREEMENT, RELEASE AND ASSUMPTION OF RISK
Liability Waiver, Membership Agreement, Media Release and Covid_19 Waiver I have requested the use of CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ facilities and/or equipment, or the purchase or provision of lessons, instruction and/or training related to weightlifting, powerlifting, Olympic lifting, gymnastics, plyometrics, mixed martial arts, calisthenics, running, rowing, climbing, jumping, throwing, Brazilian Jiu Jitsu, Parkour, Muay Thai diet, kickboxing, nutrition, injury prevention, and/or activities incidental thereto, individually and collectively (CrossFit) and the use of equipment and facilities at 4153 Lawrenceville Highway, #13, Lilburn, GA 30047 and/or any public or private location (collectively, Facilities and Equipment”). I understand that this Waiver and Release from Liability is being executed in favor of CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ and its owners, officers, agents, and employees (“Releasees”). I understand and acknowledge that serious disabilities, illness (to include “exertional rhabdomyolysis”) death, accidents and injuries can occur during CrossFit “, Personal Training, Ninja Training and FlexBuilding™ and the use of the Facilities and Equipment in which those CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ activities are held, whenever or however they occur and for such period said activities may continue. I further understand and acknowledge that attending, participating in, volunteering at or spectating at CrossFit, Ninja Training, and FlexBuilding activities may require me to perform strenuous activities, or to be exposed to conditions, individuals, equipment or events which have potential to cause death, illness, serious injury, disability, or property loss. Knowing the risks inherent in and connected with these CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC and FlexBuilding™ activities, if you are pregnant or think you may be pregnant, a doctor’s clearance should be obtained in addition to any other condition you may be suffering from. I acknowledge with full understanding of the activities I will be performing, on behalf of myself, my executors, administrators, heirs, successors, assigns, and next of kin, I HEREBY FULLY ASSUME THE RISKS OF INJURY, ILLNESS, DISABILITY, DEATH, OR LOSS OR DAMAGE TO PERSON OR PROPERTY INHERENT IN, AND/OR IN ANY WAY CONNECTED WITH ATTENDING, PARTICIPATING IN, AND SPECTATING A GYM EVENT OR OTHER CROSSFIT/NINJA ACTIVITY AT THE FACILITIES EVEN IF ARISING FROM THE NEGLIGENCE OF OTHER PERSONS EXECUTING A SIMILAR WAIVER AND RELEASE FROM LIABILITY. I understand that I will not be permitted to participate in CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ activities without executing this Waiver and Release. As a condition of my participation in CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ activities, I grant CrossFit Lilburn 678 NinjaKour and NinjaKour Franchise, LLC / FlexBuilding™ and its employees, members, partners, officers and agents perpetual and non-revocable permission to use my name, photographs and video in which my image and likeness appears in connection with my participation in CrossFit Lilburn 678 NinjaKour and NinjaKour Franchise, LLC / FlexBuilding™ of Ninja including any advertisements, or media and electronic displays and transmissions thereof (herein “Likeness Rights”). I release CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ and its employees, members, partners, officers and agents from any and all liability for damages for use in any manner or media of the Likeness Rights, and waive any and all claims and causes of action for damages for use of the Likeness Rights, including but not limited to: unauthorized use of my likeness, image, character or persona; violation of my right or publicity or privacy; and for copyright or moral rights infringement, defamation, or being cast in a bad light.
I understand that CrossFit Lilburn 678 / NinjaKour / NinjaKour Franchise, LLC / FlexBuilding™ is not responsible for lost or stolen articles. I understand and agree that this Agreement is a full and final release covering all known and unknown and unanticipated injuries, debts, claims, or damages to him/her that have arisen or may have arisen from any matters, acts, omissions, or dealings released in this agreement, including but not limited to the use of the photographs and likeness Rights. The undersigned acknowledges that he/she is aware that he/she may hereafter discover facts in addition to, or different from, those which he/she now knows or believes to be true, but it is his/her intention hereby, fully and finally and forever, to settle and to release any and all matters, disputes, differences, known or unknown, suspected or unsuspected, that do now exist, may exist or heretofore have existed with respect to those matters described herein. I expressly waive and relinquish any and all rights or benefits that I may now have, or in the future may have as to these matters released herein, similar law or any state or territory of the United States. Said section provides as follows:
“A general release does not extend to claims which the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him must have materially affected his settlement with the debtor.”
By signing below, the undersigned also waives any and all rights he/she may have, independently or on my behalf, in connection with my image or likeness on such photograph(s) and Likeness Rights, and consents to, joins with and ratifies all grants of permission, waivers, discharges and releases set forth herein above.
I AGREE NOT TO BRING ANY CLAIM AGAINST RELEASEES, which claims concern in any way death, injury, damage or loss of any type or nature, which arise out of, are related to, or are in any way connected with attending, participating in, volunteering at or spectating at CrossFit Lilburn 678 NinjaKour and NinjaKour Franchise, LLC / FlexBuilding™ Activities, and/or which arise out of or are connected to in any way with my use of, or my presence at the Facility(ies) at which (those) activities held, whether injury, death or disability, loss or damage is caused in whole or in part by negligence, gross carelessness, or other acts or failure to act of those persons or entities.
I HEREBY AFFIRM AND ACKNOWLEDGE THAT I HAVE READ THIS DOCUMENT. I HEREBY AFFIRM AND ACKNOWLEDGE THAT I UNDERSTAND ITS CONTENTS AND AGREE TO BE BOUND THEREBY. IF I AM UNDER THE AGE OF EIGHTEEN YEARS, MY PARENT/GUARDIAN HAS READ AND COMPLETED THE SECTION BELOW.
PARENTAL CONSENT AND RELEASE
The undersigned parent/nature/legal guardian hereby executes the foregoing Waiver and Release on behalf of the minor named herein and I hereby bind myself; the minor named herein, his/her executor, administrators, heirs, successors, assigns, and next of kin, to the terms of this Waiver and Release. I represent that I have the legal capacity and authority to act for, or on behalf of, the minor names herein. I agree to indemnify and hold harmless the persons and entities names herein from any claims and liabilities, which may be assessed against them as a result of, or arising out of my legal capacity or my authority to act for and on behalf of the minor named herein in the execution of the Waiver and Release or my execution of the Waiver and Release. Membership Agreement Membership Privileges, Notices, Disclosure & Agreement Notice:
Any holder of the agreement is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof.
Covid-19 Waiver: Assumption of the Risk and Waiver of Liability Relating to Coronavirus/COVID-19
The novel coronavirus, COVID-19, has been declared a worldwide pandemic by the World Health Organization. COVID-19 is extremely contagious and is believed to spread mainly from person-to-person contact. As a result, federal, state, and local governments and federal and state health agencies recommend social distancing and have, in many locations, prohibited the congregation of groups of people.
CrossFit 678 and NinjaKour has put in place preventative measures to reduce the spread of COVID-19; however, CrossFit 678 and NinjaKour cannot guarantee that you or your child(ren) will not become infected with COVID-19. Further, attending CrossFit 678 and NinjaKour could increase your risk and your child(ren)’s risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that you may be exposed to or infected by COVID-19 by attending CrossFit 678 and NinjaKour and that such exposure or infection may result in personal injury, illness, permanent disability, and death. I understand that the risk of becoming exposed to or infected by COVID-19 at the CrossFit 678 and NinjaKour may result from the actions, omissions, or negligence of myself and others, including, but not limited to, CrossFit 678 and NinjaKour employees, volunteers, and program participants and their families.
I voluntarily agree to assume all of the foregoing risks and accept sole responsibility for any injury to my myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I may experience or incur in connection with my attendance at the CrossFit 678 and NinjaKour. On my behalf, and on behalf of my children, I hereby release, covenant not to sue, discharge, and hold harmless CrossFit 678 and NinjaKour employees, agents, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. I understand and agree that this release includes any Claims based on the actions, omissions, or negligence of the Club, its employees, agents, and representatives, whether a COVID-19 infection occurs before, during, or after participation in any CrossFit 678 and NinjaKour program. ” WARNING
Under Georgia law, there is no liability for an injury or death of an individual entering these premises if such injury or death results from the inherent risks of contracting COVID-19. You are assuming this risk by entering these premises.” MEDIA RELEASE FORM By signing at the end, I hereby give Dr. Robert R. Pruni, NinjaKour, CrossFit Lilburn 678 and FlexBuilding and any associated companies will hereby collectively be known as “The Companies” and acting pursuant to The Companies authority, permission to publish my testimonial, video and or photographs. I herby authorize The Companies to:
1. Use my name, interview, photograph and testimonial in connection to any press, media release, news article, collateral material, video and video testimonial.
2. Use my name and biographical material in connection with the same.
3. Publish or distribute the media through print/video, multi-media or any other advertising mediums in whole or in part without restrictions or limitations.
I hereby consent to the release of said interview, testimonial and photograph or any other medium for the above-stated purposes. I will make no monetary and or any other claim against Dr. Robert R. Pruni or The Companies for use of the interview, photograph, or video and I hereby release Dr. Robert R. Pruni or The Companies from all liability from use or such interview, photographs or videos.
I agree

4153 Lawrenceville Hwy, Lilburn, GA 30047
(678) 671-3539
docpruni@ninjakour.ninja

Copyright ©2023 All rights reserved

Skip to content