Intake Form

Contact Information
Name*
Date of Birth:*
Phone Number*
Email Address*
How did you learn about us?*
Emergency Contact Name:*
Emergency Contact Phone Number*
Have you done CrossFit or weightlifting before?*
Where?
Please fill in all required fields.
Health & Medical Information
Do you have any health concerns we should be aware of?*
Please check any areas of concern regarding your health:
Please elaborate on any concerns checked above.
Please list any conditions (past or present) not listed above.
Are you pregnant?*
Please list any medications, remedies or treatments you are currently taking.
Please fill in all required fields.
Waiver & Legal Information
This form of exercise does not claim to treat any of the conditions listed above or any that I have added. I release Hardcore Fitness / Canandaigua CrossFit® and all personnel from any liability that may occur as a result of the fitness program. The Hardcore / CrossFit® program are in no way intended as a substitute for medical counseling.*
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. Canandaigua Crossfit® / Cross Training (“the Club”) ​has put in place preventative measures to reduce the spread of COVID-19; however, the Club ​cannot guarantee ​that you will not become infected with COVID-19. Further, ​attending the Club could increase ​your risk of contracting COVID-19. By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending the Club 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 Club may result from the actions, omissions, or negligence of myself and others, including, but not limited to, Club 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 myself (including, but not limited to, personal injury, disability, and death), illness, damage, loss, claim, liability, or expense, of any kind, that I or my child(ren) may experience or incur in connection with my attendance at the Club or participation in Club programming (“Claims”). On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless the Club, its 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 Club program.*
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