CrossFit KOA Client Release Form
This release is entered into between the undersigned and CrossFit KOA, LLC. The purpose of
CrossFit KOA, LLC is to provide fitness and exercise instruction. The undersigned hereby
acknowledges and agrees to the following:

1. Acknowledges there is risk of sustaining bodily injury during the course of exercise
and/or while on CrossFit KOA premises. It is the undersigned’s responsibility to check
with his/her physician/medical professional to determine if able to safely perform
strenuous exercise or physical activity. CrossFit KOA’s trainers are not physicians and
are not trained or qualified in any way to provide medical diagnosis, medical treatment,
psychotherapy, or any other type of medical advice.

2. The undersigned expressly waives, releases, discharges, and agrees not to sue CrossFit
KOA, LLC for any liability, including but not limited to death, disability, personal injury or
action of any kind that occurred as a result of the undersigned participating in training
programs or training for sporting/fitness activities, or for any other incidents occurring
while on CrossFit KOA, LLC premises.

3. The undersigned agrees that this is the full agreement between the parties, and that
CrossFit KOA, LLC and anyone else speaking on CrossFit KOA, LLC’s behalf has not
verbally contradicted any of the terms of this release and that the undersigned has
entered into this agreement freely and voluntarily without force or coercion.

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Player First Name *
Player Last Name *
Cranford Hockey Club Level *
Player Date of Birth *
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Street Address *
CIty *
State *
Zip Code *
Email *
Phone *
Emergency Contact Name *
Emergency Contact Phone Number *
Parent or Guardian Name/Signature *
Date *
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