EmailMe Form - POST COVID 19 WAIVER & RELEASE REPS GYM INDEMNITY

POST COVID 19 WAIVER & RELEASE REPS GYM INDEMNITY

HARMLESS, WAIVE AND RELEASE FOR PARTICIPATION WITH REPS MMA CROSSFIT EDWARD STR, 101 OMNIPARK BUILDING, 102 EDWARD STREET, BELLVILLE, 7530, EITHER AT THEIR FACILITIES OR WITH THEIR REPRESENTATIVES / COACHES / AGENTS / MANAGERS AT ANY VENUE / PLACE OR VIA FACEBOOK / ZOOM / WHAT'S APP / VIDEO CONTENT OR ANY PLATFORM NOT MENTIONED HERE.

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CHAT TO REPS VIA WHATS APP HERE FOR HELP, SIMPLY COPY LINK IN YOUR BROWSER OR GOOGLE TO CHAT (YOU NEED WHATS APP INSTALLED ON YOUR DEVICE :

https://api.whatsapp.com/send?phone=+27826417202

THIS DOCUMENT DOES NOT REMOVE THE STATUTORY OBLIGATIONS OF REPS MMA CROSSFIT EDWARD STR NOR SEEK TO EXCLUDE LITIGATION FOR GROSS NEGLIGENCE. THE INTENT OF THIS DOCUMENT IS TO ENTER INTO AN AGREEMENT BETWEEN THE PARTICIPANT OR THEIR PARENT/GUARDIAN AND REPS MMA CROSSFIT EDWARD STR ACKNOWLEDGING THE RISKS ASSOCIATED WITH PARTICIPATION IN FITNESS AND OR MARTIAL ARTS, WHETHER WITH A COACH / STAFF MEMBER OF REPS MMA CROSSFIT EDWARD STR OR BY THE PARTICIPANT SELF ON THEIR OWN OR GROUP ACTIVITIES AND WHERE APPLICABLE, INCLUDES A VOLUNTARY ASSUMPTION OF RISK BY PARTICIPANTS, PARENTS AND LEGAL GUARDIANS.

PARTICIPANT CONSENT, WAIVER AND RELEASE FROM LIABILITY:

I acknowledge that participating in activities sanctioned REPS MMA CROSSFIT EDWARD STR involves a risk of personal injury to myself and others or even Death, and damage or theft to property belonging to others and myself. I knowingly and voluntarily agree to the terms and conditions outlined in this Waiver and Release from Liability.

IN EXCHANGE FOR BEING PERMITTED TO PARTICIPATE IN REPS MMA CROSSFIT EDWARD STR PROGRAMS, I AGREE TO THE FOLLOWING:
a. I am in good health, have no physical conditions that affect my ability to participate in any sanctioned activity conducted by REPS MMA CROSSFIT EDWARD STR and have not been advised otherwise by a medical practitioner. I also further undertake to complete the COVID 19 questionnaire below, on behalf of the participant, whether for myself or for another person, and that i will do so to the best of my ability. I understand that providing false information may lead to severe consequence for the participant / parent / family member / friend / legal guardian / guardian.

b. I agree that I will immediately advise REPS MMA CROSSFIT EDWARD STR if I observe any unsafe condition with grounds, facilities, video material and instructionals.

c. I assume all risks associated with my participation including without limitation the risk of any negligence or recklessness by other participants. I understand that there may be risks involved which are not known to me or to REPS MMA CROSSFIT EDWARD STR at this time or at the time of the activities in which I may participate, and agree to assume such unforeseeable risks, INCLUDING BUT NOT LIMITED, serious injury and even Death.

d. I agree to indemnify, defend and hold harmless to REPS MMA CROSSFIT EDWARD STR and their employees, agents and volunteers from and against any claims, causes of action, damage, judgements, liabilities, fees (including legal fees), costs and expenses incurred by REPS MMA CROSSFIT EDWARD STR as a result of my unlawful actions or failure to act during any activity.

This Waiver is a legally binding agreement and will be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law. Any provisions found to be unenforceable shall not affect the validity of enforceability of any other provisions, which may be modified by a court having jurisdiction.

REPS MMA CROSSFIT EDWARD STR will not reimburse members who are unable to sustain the full quantity of programmed Fitness session. Specific cases with external complications will be looked at case by case.

Covid 19:

Please understand that despite all the precautions that you, other members, and/or Reps MMA CrossFit Edward Str may take, we cannot guarantee your health or safety, and you may still be exposed to COVID-19, including through interactions with other individuals who have COVID-19. By executing this release and gaining access to the facility, you, on behalf of yourself, your heirs, beneficiaries, representatives, successors and assigns: (1) voluntarily assume all risks associated with any exposure to COVID-19, including, but not limited to suffering any type of medical condition, illness and, potentially, death; and (2) knowingly and voluntarily waive, release, covenant not to sue, forever discharge, indemnify, and hold harmless RepsMMACrossFitEdwardStr, its parents and subsidiaries and their respective officers, directors, employees, contractors, agents, representatives, successors, coaches, trainers and assigns (“Released Parties”) includes without limitation Reps MMA CrossFit Edward Str, Rio Grappling Club, BullyStop, RHMMA, Parents, each of their respective past, present and future parents, members, Affiliates, subsidiaries, divisions, predecessors, successors, assigns, funds, employee benefit plans and trusts, and all past, present and future managers, directors, officers, partners, agents, employees, attorneys, representatives, consultants, associates, fiduciaries, plan sponsors, administrators and trustees of each of the foregoing and each of their respective successors and assigns, from any and all liability, damages, losses, suits, demands, causes of action to the fullest extent permitted by the laws of this state/ province/ Country, or any other claims of any nature whatsoever, arising out of or relating in any way to your use of the facility and your potential exposure to COVID-19.
I have read this document and I understand that by signing below, I have given up substantial rights, I have voluntarily signed this release, without any duress or undue pressure from REPS MMA CROSSFIT EDWARD STR.
(PLEASE DO NOT AUTOFILL) Name / Surname of student / Member *
First Middle Last
Phone number of member, if over 18, or Parent / Legal Guardian, if under 18. *
(PLEASE DO NOT AUTOFILL) Email address of member, if over 18, or Parent / Legal Guardian, if under 18. *
Participant is *
Under the age of 18
Over the age of 18
Should the participant be under the age of 18 years, a parent or guardian must agree to terms and conditions of a participant in a sanctioned activity of REPS MMA CROSSFIT EDWARD STR contained in this Agreement and assume responsibility for the actions/ inaction of the participant.
Signature of member, if over 18, or Parent / Legal Guardian, if under 18. *
Clear
Date Time *
DD / MM / YYYY HH : MM AM/PM

Please choose activity /activities applicable to student / Member according to the respective payment package chosen by Student / Member, if over 18, or Parent / Legal Guardian, if under 18. ALL CLASSES ARE SUBJECT TO BOOKING THROUGH OUR BOOKING APP. CLASS TIMES ARE SUBJECT TO CHANGE. THERE IS A LIMITED NUMBER OF ONLY 18 MEMBERS PER CLASS (PRIOR TO COVID 19) BUT DURING COVID 19, ONLY 12 MEMBERS PER CLASS ON THE CROSSFIT AREA AND 30 (PRIOR TO COVID 19) BUT DURING COVID 19, ONLY 20 ON THE MAT AREA. THIS AMOUNT IS SUBJECT TO CHANGE AND WILL BE COMMUNICATED TO YOU IN SUCH EVENT. PLEASE NOTE THAT WE ARE ALSO ABLE TO OFFER ONLINE MATERIAL AND OUR GYM IS A SPECIALIZED SKILLS TRAINING CENTER AND NOT ONLY LIMITED TO AVAILABILITY OF EQUIPMENT, AS WITH OTHER COMMERCIAL GYMS, HENCE THE REASON FOR PAYING HIGHER FEES AND USING LESS EQUIPMENT. IN THE EVENT THAT REPS GYM WILL NOT BE AVAILABLE, FOR YOU TO USE, DUE TO A ' FORCE MAJURE " OR ' VIS MAJOR " INCLUDING BUT NOT LIMITED TO A EPIDEMIC OR PANDEMIC EVENT, THEN OUR COACHES ARE EQUIPPED TO OFFER YOU THE SAME TRAINING AND TIMES VIA ONLINE MATERIAL AND OR LIVE CLASSES. THE POSSIBILITY WILL BE AVAILABLE TO RENT EQUIPMENT FROM US WITH ONLY A REFUNDABLE DEPOSIT PAYABLE. WE CAN ALSO TRAIN AND TEACH AT OTHER VENUES WHICH WILL SUIT BOTH PARTIES AS A POSSIBILITY. YOU ACCEPT THAT BY SIGNING UP WITH US YOU ARE DOING SO BY NOT LIMITING IT TO OUR FACILITY ONLY AND THAT WE WILL USE A CASE BY CASE STUDY WITH REGARDS TO SUCH SITUATIONS. THE "IMPOSSIBILITY FACTOR" WILL NOT BE USED AGAINST REPS GYM, DUE TO SUCH EVENT/S, AS REPS GYM AND IT'S STAFF HAVE BEEN PREPARED BY THE COVID 19 EVENT AND ARE THEREFORE PREPARED TO OFFER THE SAME QUALITY TRAINING.

	CHOOSE
CROSSFIT
KICK BOXING
MUAY - THAI
MIXED MARTIAL ARTS
BRAZILIAN JIU - JITSU
BOXING
BOX - HIGH INTENSITY INTERVAL TRAINING
PERSONAL TRAINING
GENERAL GYM USE
KIDS BULLYSTOP AND FITNESS
MEDI CLINIC STUDENTS ONLY

Participant is *
Under the age of 18
Over the age of 18
Should the participant be under the age of 18 years, a parent or guardian must agree to terms and conditions of a participant in a sanctioned activity of REPS MMA CROSSFIT EDWARD STR contained in this Agreement and assume responsibility for the actions/ inaction of the participant.
I accept and agree to these terms *
Signature of Aceptance
Signature *
Clear
PLEASE NOTE THAT ALTHOUGH COVID 19 HAS COME TO AN END, THAT THESE QUESTIONS WILL STILL BE VALID FOR SAFETY REASONS, HOWEVER PLEASE NOTE THAT WE ONLY ASK THEM FOR OUR OWN RECORDS AND THAT IT WILL NOT BE NECESSARY FOR GOVERMENTAL TRACK AND TRACE. YOU WILL NOT BE ABLE TO TICK "YES" FOR ANY OF THE FOUR (4) QUESTIONS DIRECTLY BELOW REGARDING COVID 19. SHOULD ONE OR MORE OF THE ANSWERS BE "YES", THEN PLEASE CONTACT THE GYM ON EITHER WHATS APP 0826417202 OR EMAIL reps_fitness@yahoo.com, OR BOTH, BEFORE COMING TO THE GYM OR PROCEEDING ANY FURTHER.

COVID 19 QUESTIONAIRE. "I" AND "YOU" REFER TO THE MEMBER / STUDENT WANTING TO PARTICIPATE IN ACTIVITIES LISTED HERE, WHETHER MEMBER / STUDENT IS OVER 18 YEARS OF AGE AND COMPLETING IT BY THEMSELVES AND OR PARENT/S LEGAL GUARDIAN/S ON BEHALF OF A STUDENT / MEMBER UNDER 18 YEARS OF AGE : Checkbox Grid *

	"NO"
HAVE YOU OR ANYONE CLOSE TO YOU CONTRACTED COVID 19
HAVE YOU OR ANYONE CLOSE TO YOU BEEN TESTED POSITIVE FOR COVID 19
DO YOU OR ANYONE CLOSE TO YOU CURRENTLY FEEL SICK OR HAVE YOU BEEN FEELING SICK RECENTLY
HAVE YOU OR ANYONE CLOSE TO YOU BEEN IN CONTACT WITH A PERSON WHICH HAD COVID 19

PLEASE NOTE THAT YOU WILL NOT BE ABLE TO TICK "NO" FOR ANY OF THE FOURTEEN (14) QUESTIONS DIRECTLY BELOW REGARDING COVID 19. SHOULD ONE OR MORE OF THE ANSWERS BE "NO", THEN PLEASE CONTACT THE GYM ON EITHER WHATS APP 0826417202 OR EMAIL reps_fitness@yahoo.com, OR BOTH, BEFORE COMING TO THE GYM OR PROCEEDING ANY FURTHER.

COVID 19 QUESTIONNAIRE :"I" AND "YOU" REFER TO THE MEMBER / STUDENT WANTING TO PARTICIPATE IN ACTIVITIES LISTED HERE, WHETHER MEMBER / STUDENT IS OVER 18 YEARS OF AGE AND COMPLETING IT BY THEMSELVES AND OR PARENT/S LEGAL GUARDIAN/S ON BEHALF OF A STUDENT / MEMBER UNDER 18 YEARS OF AGE. Checkbox Grid *

	"YES"
I AGREE THAT I WILL NOT COME TO THE GYM OR BE IN CONTACT WITH THE COACHES OR OTHER MEMBERS SHOULD I START TO FEEL SICK, SHOW SYMPTOMS OF COVID 19 OR HAVE BEEN TESTED POSITIVE FOR COVID 19
ARE YOU WILLING TO KEEP A DISTANCE OF 1.5 METERS WHILE IN THE GYM, SHOULD GOVERNMENT IMPOSE THIS RULE AGAIN
ARE YOU WILLING TO WEAR A MASK AND OR FACE SHIELD TO TRAIN AND WHILE IN GYM, SHOULD GOVERNMENT RULES REQUIRES SUCH RULE AGAIN
ARE YOU WILLING TO TRAIN WITH ONE PARTNER UNTIL SAFE TO TRAIN WITH OTHERS, SHOULD GOVERNMENT REQUIRES SUCH A RULE AGAIN
ARE YOU WILLING TO TRAIN WITHOUT A PARTNER UNTIL SAFE TO TRAIN WITH OTHERS, SHOULD GOVERNMENT REQUEST SUCH A RULE AGAIN
I WILL INFORM THE GYM AND OR COACHES DIRECTLY AND IMMEDIATELY SHOULD I SHOW SYMPTOMS OR FEEL SICK OR HAVE BEEN IN CONTACT WITH ANY PERSON SUSPECTED OF HAVING COVID 19
I WILL CLEAN AND SANITIZE MY HANDS AND EQUIPMENT BEFORE, DURING AND AFTER TRAINING WHILE IN THE GYM
ARE YOU WILLING TO UNDERGO A TEMPERATURE CHECK BEFORE PARTICIPATING AT REPS AND ARE YOU WILLING TO LEAVE AND GET TESTED FOR COVID 19, SHOULD YOUR TEMPERATURE BE MORE THAN 37.5 DEGREES CELCIUS, SHOULD GOVERNMENT REQUEST SUCH A RULE AGAIN
DO YOU AGREE THAT, SHOULD YOU TEST POSITIVE FOR COVID 19, THAT YOU MIGHT NOT HAVE BEEN INFECTED AT THE REPS FACILITY AND THAT YOU WILL IMMEDIATELY CONTACT THE GYM.
I AGREE THAT IN THE CASE THAT I HAVE BEEN DIAGNOSED WITH COVID 19 OR SIMPLY IF I FEEL SYMPTOMS OF COVID 19, AS PER DISPLAY OF SYMPTOMS BELOW, THAT I WILL SELF QUARANTINE FOR AT LEAST TWO (2) TO THREE (3) WEEKS AND RECOVER 100% BEFORE RETURNING
I AGREE TO BOOK MY CLASSES AT LEAST 24 HOURS IN ADVANCE, AND CANCEL AT LEAST 12 HOURS IN ADVANCED. SHOULD THERE NOT BE ENOUGH SPACE IN CLASS, THEN I WILL NOT HOLD REPS GYM ACCOUNTABLE FOR ANY LOSS AS A RESULT OF THIS.
I AGREE TO CANCEL MY BOOKING AND NOTIFY MY COACH DIRECTLY, AT LEAST TWELVE ( 12 ) HOURS BEFORE THE CLASS IN SUCH CASE
I AGREE TO NOT USE THE SHOWER AND CHANGING FACILITY DURING COVID 19 AND AGREE TO A TEMPERATURE SCREENING AND THE SHARING OF MY PERSONAL INFORMATION TO THE COVID 19 OR GOVERNMENT OFFICIALS UPON SUCH REQUESTS, SHOULD GOVERNMENT REQUEST SUCH A RULE
I UNDERSTAND AND AGREE TO ALL OF THE ABOVE AND WILL FIRST CONTACT THE GYM BEFORE SIGNING UP OR JOINING A FREE CLASS SHOULD I NOT AGREE TO ANYTHING AND STATE IT IN WRITING

MOST COMMON SIGNS AND SYMPTOMS OF COVID 19 AS PER WORLD HEALTH ORGANIZATION:
1. DRY COUGH
2. SHORTNESS OF BREATH
3. FEVERISH
4. TEMPERATURE OF MORE THAN 37.5 DEGREES CELSIUS
5. TIREDNESS

LESS COMMON SYMPTOMS:

1. ACHES AND PAINS
2. SORE THROAT
3. DIARRHEA
4. CONJUNCTIVITIS
5. HEADACHES
6. LOSS OF TASTE OR SMELL
7. A RASH ON SKIN OR DISCOLORATION OF FINGERS OR TOES

SERIOUS SYMPTOMS:

1. CHEST PAIN OR PRESSURE
2. LOSS OF SPEECH OR MOVEMENT

RECOMMENDATION BY THE WORLD HEALTH ORGANIZATION:

SEEK IMMEDIATE MEDICAL ATTENTION IF YOU HAVE SERIOUS SYMPTOMS. ALWAYS CALL FIRST BEFORE VISITING YOUR DOCTOR OR HEALTH CARE FACILITY.
THE EMERGENCY HOTLINE FOR COVID 19 IN SOUTH AFRICA IS CURRENTLY: 0800 029 999

PEOPLE WITH MILD SYMPTOMS WHO ARE OTHERWISE HEALTHY SHOULD MANAGE THEIR SYMPTOMS AT HOME, RESPONSIBLY, AND FOR AT LEAST 2 TO 3 WEEKS BEFORE RETURNING TO BE IN CONTACT WITH OTHER PEOPLE.

ON AVERAGE IT TAKE 5 TO 6 DAYS FROM WHEN SOMEONE IS INFECTED WITH THE VIRUS FOR SYMPTOMS TO SHOW, HOWEVER IT CAN TAKE UP TO 14 DAYS.
I HAVE READ AND UNDERSTAND THE ABOVE AND WILL EXPLAIN IT TO MY FAMILY/FRIENDS:
Name of member, if over 18, or Parent / Legal Guardian, if under 18. *
First Middle Last
Date Time *
DD / MM / YYYY HH : MM AM/PM
Phone of member, if over 18, or Parent / Legal Guardian, if under 18. *
Signature of member, if over 18, or Parent / Legal Guardian, if under 18. *
Clear
CONTACT: reps_fitness@yahoo.com | 021 910 2570 or 082 641 7202
www.reps.capetown

MOST COMMON SIGNS AND SYMPTOMS OF COVID 19 AS PER WORLD HEALTH ORGANIZATION:

I HAVE READ AND UNDERSTAND THE ABOVE AND WILL EXPLAIN IT TO MY FAMILY/FRIENDS:

CONTACT: reps_fitness@yahoo.com | 021 910 2570 or 082 641 7202