EmailMeForm
NewCov CrossFit Registration
About:
Free Community Class - Noon - 1PM
Address:
NewCov CrossFit
15 West 6th Street
Newport, KY 41071
<label class="emf-label-desc" for="element_0">Name <span>*</span></label> <div class="emf-div-field"><span style="width:60px"> <input class="validate[required]" style="width:100%" value="" id="element_2" name="element_2" type="text" /> <label for="element_2" class="emf-bottom-label emf-text-center">First</label> </span><span style="width:100px"> <input class="validate[required]" style="width:100%" value="" id="element_3" name="element_3" type="text" /> <label for="element_3" class="emf-bottom-label emf-text-center">Last</label> </span></div> <div class="emf-clear"></div> </li><li id="emf-li-5" class="emf-li-field emf-field-email data_container cell_align_left"> <label class="emf-label-desc" for="element_5">Email <span>*</span></label> <div class="emf-div-field"><input id="element_5" name="element_5" class="validate[required,custom[email]]" value="" size="30" type="text" /></div> <div class="emf-clear"></div> </li><li id="emf-li-6" class="emf-li-field emf-field-phone data_container "> <label class="emf-label-desc" for="element_6">Phone <span>*</span></label> <div class="emf-div-field"> <span> <input maxlength="3" value="" id="element_6_1" name="element_6[]" type="text" class="emf-input-w30 validate[required,custom[onlyNumber],length[3,3]]" /> <label for="element_6_1" class="emf-bottom-label">###</label> </span><span class="emf-sep">-</span><span> <input maxlength="3" value="" id="element_6_2" name="element_6[]" type="text" class="emf-input-w30 validate[required,custom[onlyNumber],length[3,3]]" /> <label for="element_6_2" class="emf-bottom-label">###</label> </span><span class="emf-sep">-</span><span> <input maxlength="4" value="" id="element_6_3" name="element_6[]" type="text" class="emf-input-w40 validate[required,custom[onlyNumber],length[4,4]]" /> <label for="element_6_3" class="emf-bottom-label">####</label> </span></div> <div class="emf-clear"></div> </li><li id="emf-li-7" class="emf-li-field emf-field-drop_down_list data_container "> <label class="emf-label-desc" for="element_7">How did you hear about us? <span>*</span></label> <div class="emf-div-field"><table class="emf-field-list" my_statement_order_type=""> <tr class='emf-banding-odd'> <th>NewCov Facebook Ad</th><td> <select id="element_8" name="element_8" class="validate[required]" my_choice_order_type=""><option value="" selected="selected" my_order_property="first">Please select</option><option value="CrossFit Facebook Ad " >CrossFit Facebook Ad </option><option value="CrossFit Instagram Ad" >CrossFit Instagram Ad</option><option value="NewYou Challenge Ad " >NewYou Challenge Ad </option><option value="I was referred by a member of this gym" >I was referred by a member of this gym</option><option value="Google Search " >Google Search </option><option value="Other " >Other </option></select></td> </tr> </table> </div> <div class="emf-clear"></div> </li><li id="emf-li-9" class="emf-li-field emf-field-section_break cell_align_left"> <div class="emf-div-field-section"><div class="emf-section-separator"></div> <h3 id="element_9" name="element_9"></h3></div> <div class="emf-clear"></div> </li><li id="emf-li-10" class="emf-li-field emf-field-signature data_container "> <label class="emf-label-desc" for="element_10">RELEASE OF LIABILITY, WAIVER OF CLAIMS, AND ASSUMPTION OF RISK AGREEMENT<br /> <br /> This is a Release of Liability, Waiver of Claims, and Assumption of Risk Agreement (“Agreement”) made by and between Covington Fitness, LLC, D.B.A. NewCov CrossFit (“Facility”) and the undersigned member/guest.<br /> <br /> 1.Assumption of Liability Generally: I understand that I must sign a Release of Liability, Waiver of Claims, and Assumption of Risk Agreement. I acknowledge that the Facility would not allow me to use its services, including, but not limited to, use of exercise equipment, and the attendance in any class unless I previously sign this Agreement. I understand that I am under no obligation to use the Facility, its equipment, or to participate in any class and that such use or participation is voluntary. I hereby agree to freely, voluntarily, and expressly ASSUME and ACCEPT any and all risks of injury or death that may occur or result from my use of or presence at the Facility.<br /> <br /> 2. Release of Liability: I accept the premises and exercise equipment for use AS IS and without any warranties expressed or implied. In consideration for the use of the Facility’s services, equipment, or participation in any class, I hereby agree as follows: To the fullest extent permitted by law, I hereby release, hold harmless, and waive any and all claims that I have or may have in the future against all individuals and entities including the Facility, its affiliates, and their respective officers, independent contractors working at the Facility, employees, directors, shareholders, attorneys, predecessors, successors, and assigns from any and all liability for any loss, damage, injury, or expense that I may suffer or that my next of kin may suffer as a result of my use or presence at the Facility, including use of exercise equipment, participation in any class due to any cause whatsoever including negligence on the part of the Facility, breach of contract, breach of warranty, or any other legal theories, and I accept full liability and responsibility for any and all such injuries or damages.<br /> <br /> 3. Personal Property and Valuables: I agree that the Facility will not be liable for the loss or theft of, or damage to, my personal property.<br /> <br /> 4. Understanding of Release: I acknowledge that I have carefully read, understood, and agree to the terms of this Agreement. I give this release with the understanding that physical exercise with or without the use of exercise equipment and machines and whether or not in an exercise class has risks of a variety of physical injuries and illness including muscle pulls, sprains, and the risk of heart attack which can result in death. I am aware that this is a legally binding agreement and that I am not relying on any oral or written representations other than what is set forth herein to sign in this Agreement. I have read and understand this Agreement and I am aware that by signing this Agreement I may be waiving certain legal rights including the right to sue the Facility and all individuals and entities associated with the Facility as set forth above, resulting from the my use of equipment, participation in a class or presence at the Facility, its parking lot, and/or the outside exercise premises.</label> <div class="emf-div-field"><div class="emf-new-signature"><div class='emf-signature'></div><input type="text" autocomplete="one-time-code" name="element_10" class="emf-hidden-input-for-fancy-field validate[optional]"><div class="emf-signature-operation"><a href="javascript:void(0)" onclick="EMF_jQuery('#emf-li-10 .emf-signature').jSignature('clear');EMF_jQuery('#emf-li-10 .emf-hidden-input-for-fancy-field').val('');">Clear</a></div></div><div class="emf-div-instruction">Please Read and Sign and Date </div></div> <div class="emf-clear"></div> </li><li id="emf-li-11" class="emf-li-field emf-field-datetime data_container "> <label class="emf-label-desc" for="element_11">Date Time <span>*</span></label> <div class="emf-div-field"><span class="emf-field-datetime-month"> <input maxlength="2" id="element_11_year-mm" name="element_11_month" value="" class="validate[required,custom[onlyNumber],length[2,2],lengthValue[1,12]] emf-input-w20" type="text" size="2" /> <label for="element_11_year-mm" class="emf-bottom-label">MM</label> </span><span class="emf-sep">/</span><span class="emf-field-datetime-day"> <input maxlength="2" id="element_11_year-dd" name="element_11_day" value="" class="validate[required,custom[onlyNumber],length[2,2],lengthValue[1,31]] emf-input-w20" type="text" size="2" /> <label for="element_11_year-dd" class="emf-bottom-label">DD</label> </span><span class="emf-sep">/</span><span class="emf-field-datetime-year"> <input maxlength="4" id="element_11_year" name="element_11_year" value="" class="validate[required,custom[onlyNumber],length[4,4]] emf-input-w40" type="text" size="4" /> <label for="element_11_year" class="emf-bottom-label">YYYY</label> </span><span> <input type="hidden" id="element_11_" class="datepicker" my_date_format="mm/dd/yy"/> </span></div> <div class="emf-clear"></div> </li> <li id="emf-li-post-button" class="left"> <input src="//assets.emailmeform.com//builder/images/submit-orange.png" type="image" alt="Submit" onmouseover="return true;"/> </li> </ul> <input name="element_counts" value="12" type="hidden" /> <input name="embed" value="form" type="hidden" /> </form> </div><img id="emf-form-shadows" src="//assets.emailmeform.com/images/themes/bottom.png?bWFzdGVy"></div> <script type="text/javascript" src="https://ajax.googleapis.com/ajax/libs/jquery/1.8.3/jquery.min.js"></script> <script type="text/javascript"> if (typeof jQuery == 'undefined'){ document.write(unescape("%3Cscript src='https://www.emailmeform.com/builder/js/jquery-1.8.3.min.js' type='text/javascript'%3E%3C/script%3E")); 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