CrossFit Kids Fitness Program Waiver
Parent Name
*
First Name
Last Name
Phone Number
*
Email
*
example@example.com
Child Name
*
First Name
Last Name
DOB
*
-
Day
-
Month
Year
Date
Health Assessment
*
Yes
No
Do they have any current injuries?
Have they ever experienced shortness of breath or chest pains?
Are they currently exercising?
Have they participated in sport or exercise before?
Are there any exercises that you know they cannot/should not do?
Do they have any hip/pelvis problems?
Do they ever get dizzy?
Do they have diabetes?
Are they allergic to anything?
Has your child been diagnosed with Epilepsy?
You understand a doctors clearance is required if your child has any possible risks or concerns with participating in an exercise program. If you answer yes to any of these questions please provide more information in the space below:-
WARNING of ‘Rhabdomyolysis’
High intensity exercise must be approached cautiously in the beginning, a gradual increase of intensity is necessary to allow muscles cells to adapt to the new demands being placed on them. Failure to do so, provides a possibility of a condition, known as ‘Rhabdomyolysis’. In short, the muscle cells are damaged flooding the bloodstream with toxins that can overwhelm the kidneys as they attempt to cleanse the blood, leading to potential shutdown. Exercise can cause Rhabdomyolysis. It is important that you start at a reduced intensity. Brown urine, complete muscle weakness and/or swelling of joints are warning signs of ‘Rhabdo’. If you child develop these symptoms, seek medical assistance.
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