Online Waiver Kids – Part 2 (PARQ) We would love to hear from you! Please fill out the form below. Step 1 of 5 20% Child's Last Name*Please re-enter last nameChild's First Name*Please re-enter first nameParent/Guardian's Name(s)Parent/Guardian's E-mail Address*List all e-mail addresses with commas separating addresses.Physical ActivityWhat is your child's current activity level?*Sedentary (little or no exercise)Lightly active (light exercise/sports 1-3 days/week)Moderately active (moderate exercise/sports 3-5 days/week)Very active (hard exercise/sports 6-7 days a week)Extra active (very hard exercise/sports)Does your child participate in sports?YesNoWhich sports?Has your child suffered from any broken bones?YesNoIf yes, which bones have been broken? Date of occurance? Status of Recovery?Has your child suffered a head trauma?YesNoIf your child has suffered from a head trauma, date of occurance and status of recovery?Has your child been diagnosed with any of the following:Heart ConditionAllergiesAsthmaADHDDo you know any reason why your child should NOT participate in physical activity?NoYesDoes your child take any prescription or over-the-counter medicines?NoYesDo not include multi-vitamins unless to treat a specific disease or condition.Please list all medicinesDoes your child need a rescue inhailer?NoYesDoctor's Name and Phone Number Physical Activity Readiness Questionnaire (PAR-Q)Regular CrossFit training is fun and healthy. More and more people participate in CrossFit workouts each week. CrossFit is based upon constantly varied, functional movements, executed at high intensity. It is very safe and we have CrossFit training for people from age 4 to 70. However, some people should check with their doctor before they start becoming more physically active. If your child is planning to start doing CrossFit workouts, begin by answering the eight questions below. The PAR-Q will tell you if you should check with a doctor before your child starts. Common sense is your best guide when you answer these questions. Please read the questions carefully and answer each one honestly by checking YES or NO. Please answer these questions on behalf of your child.1. Has you doctor ever said that your child has a heart condition and that your child should only do physical activity recommended by a doctor?*YesNoPlease Explain2. Has your child ever felt pain in their chest when they do physical activity?*YesNoPlease Explain3. In the past month, has your child had chest pain when they were not doing physical activity?*YesNoPlease Explain4. Does your child lose their balance because of dizziness or do they ever lose conciousness?*YesNoPlease Explain5. Does your child have a bone or joint problem that could be made worse by a change in your physical activity?*YesNoPlease Explain6. Is your doctor currently prescribing drugs (for example water pills) for your child's blood pressure or heart condition?*NoYesPlease Explain7. Is your child currently taking prescription medicines of any kind?*YesNo8. Do you know of any other reason why your child should not do physical activity?*YesNoPlease ExplainYou answered YES to one or more of the questionsTalk with your doctor by phone or in person BEFORE you start CrossFitting, or BEFORE you have a fitness appraisal. Tell your doctor about the PAR-Q and which questions you answered YES. You may be able to do any activity you want - as long as you start slowly and build up gradually. Or, you may need to restrict your activities to follow those which are safe for you. Talk with your doctor about the kinds of activities you wish to participate in and follow his/her advice. We'll scale the workouts to your ability and skill level at all times, or we may have you sit out if we do not feel that it is safe for you to do the CrossFit workout.You answered NO to all of the questionsIf you answered NO honestly to all the PAR-Q questions, you can be reasonably sure that you can start training using CrossFit methods. Your workouts will be scaled until you reach a level of fitness where your trainers feel you can participate in full CrossFit workouts.When to delay becoming more activeIf you are not feeling well because of a temporary illness such as a cold or a fever - wait until you feel better. Please note: If your health changes so that you then answer YES to any of the above questions, tell your CrossFit trainer and ask whether you should change your physical activity plan. Photography and Video ReleaseParticipants involved in any activities offered by CrossFit DoneRight may be photographed or videotaped during training. The undersigned hereby consents to the use of my child's photographs and/or videos without compensation, on the CrossFit DoneRight website or in any editorial, promotional or advertising material produced and/or published by CrossFit DoneRight.Initials*Enter initials to accept photography/video release Informed Consent/Assumption of RiskI am aware that there are significant risks involved in all aspects of physical training I understand that Re-action of the heart, lungs and vascular system to exercise cannot always be predicted with accuracy. I understand that there is a risk of certain normal changes occurring during or following exercise which may include abnormalities of blood pressure or heart rate; chest, arm or leg discomfort; transient light-headedness or fainting; and in rare instances, heart attack, stroke or even death. understand that the programs and classes offered by Bacs Fitness, LLC dba CrossFit DoneRight are of a nature and kind that are extremely strenuous and can/may push my child to the limits of my physical abilities. 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 my child, their training partner, or other people around them, injury or death due to improper use or failure of equipment. I am aware that any of these above mentioned risks may result in serious injury or death to my child and/or their partner(s). serious injury or death to myself and or my partner(s}. Initials*Initial above that you accept and understand the statement above.I willingly assume full responsibility for any and all risks that I am exposing my child to as a result of my participation in Bacs Fitness, LLC dba CrossFit DoneRight programs/classes and accept full responsibility for any injury or death that may result from participation in any activity, class or physical fitness program. I herby certify that I know of no medical problems that would increase my child's risk of illness and injury as a result of participation in a fitness program designed by Bacs Fitness, LLC dba CrossFit DoneRight. With my full understanding of the above information, I agree to assume any and all risk associated with my child's participation in Bacs Fitness, LLC dba CrossFit DoneRight programs/classes.Initials*Initial above that you accept and understand the statement above.By signing this document, I acknowledge that I have voluntarily chosen for my child to participate in a program of progressive, physical exercise. By signing this document, I acknowledge being informed of the strenuous nature of the program and the potential for unusual, but possible, physiological results including, but not limited to, abnormal blood pressure, fainting, heart attack, or death. By signing this document, I assume all risk for my child's health and well-being and hold Bacs Fitness, LLC dba CrossFit DoneRight, as well as its owners, employees, and other authorized agents including independent contractors, harmless there from. ~ understand that questions about exercise procedure and recommendations are encouraged and welcome ~ Initials*Initial above that you accept and understand the statement above.Waiver and ReleaseI fully understand that a personal exercise program for my child may be strenuous and I choose for them to participate voluntarily. I accept all responsibility for my child's health and any results, injury or mishaps that may affect their well-being or health in any way. I waive any claims, demands, causes of action or any claims for relief whatsoever against, and release Bacs Fitness, LLC dba CrossFit DoneRight (as well as any of its owners, employees, or other authorized agents, including independent contractors) from any and all liability, claims and/or causes of action that I may have for injuries or other damages, arising out of participation in Bacs Fitness, LLC dba CrossFit DoneRight activities, including, but not limited to the personal training I nutritional programs and programs/classes.Initials*Initial above that you accept and understand the statement above. Submit FormIf your child's health status changes, please let a coach know or contact us at email@example.com. BAC's Fitness/CrossFit DoneRight assumes no liability for persons who undertake physical activity, and if in doubt after completing this questionnaire consult your doctor prior to physical activity. Please sign below indicating the following: I have read, understood and completed this questionnaire. Any questions I had were answered to my full satisfaction. Indemnification: I recognize that there is risk involved in the types of activities offered by Bacs Fitness, LLC dba CrossFit DoneRight. Therefore I accept financial responsibility for any injury that my child may cause either to themselves 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 Bacs Fitness, LLC dba CrossFit DoneRight, 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 Bacs Fitness, LLC dba CrossFit DoneRight. Choice of Law: The laws of the state of Maryland shall apply to any and all matters arising out of any claim. I agree that any action brought against Bacs Fitness, LLC dba CrossFit DoneRight must be decided in the courts of Montgomery County, Maryland. I have fully read and fully understand the foregoing assumption of risk, and release of liability and I understand that by 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 forn I am waiving valuable legal rights. I have carefully read this Agreement and fully understand its contents. I am aware that this is a release and waiver of my child and sign knowingly, voluntarily and of my own free will. Participants Full Name*Parent or Guardian's Name*Today's Date*MMDDYYYYParent or Guardian Signature* CommentsThis field is for validation purposes and should be left unchanged.