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THE CRYOTHERAPY PLACE, LLC WAIVER

RELEASE OF LIABILITY

READ CAREFULLY - THIS AFFECTS YOUR LEGAL RIGHTS

Avoid use of Cryotherapy if you have the following conditions:


 

Cancer

 

Pregnancy


 

Severe Hypertension (BP> 180/100)



Acute or recent myocardial infarction



Unstable angina pectoris



Arrhythmia



Symptomatic cardiovascular disease



Cardiac pacemaker



Peripheral arterial occlusive disease



Uncontrolled seizures



Severe Raynaud’s Syndrome



Fever

Tumor disease



Symptomatic lung disorders



Bleeding disorders



Severe anemia



Infection



Cold-allergy



Acute kidney and urinary tract diseases



Venous thrombosis



Acute or recent cerebrovascular accident

 

*Children under 18 must have parental consent and have a parent present during treatment.


In exchange for participation in the activity of CRYOTHERAPY organized by The Cryogen Plus, LLC, DBA the CryoPlace, organized in Georgia and/or use of the property, facilities and services of the Cryogen Plus LLC, I agree for myself and (if applicable) for the members of my family, heirs, executors or guardians, to the following:

1. AGREEMENT TO FOLLOW DIRECTIONS. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by The Cryogen Plus LLC, or the employees, representatives or agents of The Cryogen Plus LLC.  

2. ASSUMPTION OF THE RISKS AND RELEASE. I recognize that there are certain inherent risks associated with the above described activity and I assume full responsibility for personal injury to myself and (if applicable) my family members, heirs, executors or guardians and further release and discharge The Cryogen Plus LLC for injury, loss or damage arising out of my or my heirs, executors or guardians use of or presence upon the facilities of The Cryogen Plus LLC, whether caused by the fault of myself, my family, heirs, executors or guardians or other third parties.

3. INDEMNIFICATION. I agree to indemnify and defend The Cryogen Plus LLC against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family heirs, executors or guardians of or presence upon the facilities of The Cryogen Plus LLC.

4. FEES. I agree to pay for all damages to the facilities of The Cryogen Plus LLC caused by any negligent, reckless, or willful actions by me or my family, heirs, executors or guardians.

5. APPLICABLE LAW. Any legal or equitable claim that may arise from participation in the above shall be resolved under Georgia law.

6. NO DURESS. I agree and acknowledge that I am under no pressure or duress to sign this Agreement and that I have been given a reasonable opportunity to review it before signing. I further agree and acknowledge that I am free to have my own legal counsel review this Agreement if I so desire. I further agree and acknowledge that The Cryogen Plus LLC has offered to refund any fees I have paid to use its facilities if I choose not to sign this Agreement.

7. ARM'S LENGTH AGREEMENT. This Agreement and each of its terms are the product of an arm's length negotiation between the Parties. In the event any ambiguity is found to exist in the interpretation of this Agreement, or any of its provisions, the Parties, and each of them, explicitly reject the application of any legal or equitable rule of interpretation which would lead to a construction either "for" or "against" a particular party based upon their status as the drafter of a specific term, language, or provision giving rise to such ambiguity.

8. ENFORCEABILITY. The invalidity or unenforceability of any provision of this Agreement, whether standing alone or as applied to a particular occurrence or circumstance, shall not affect the validity or enforceability of any other provision of this Agreement or of any other applications of such provision, as the case may be, and such invalid or unenforceable provision shall be deemed not to be a part of this Agreement.

9. DISPUTE RESOLUTION. The parties will attempt to resolve any dispute arising out of or relating to this Agreement through friendly negotiations amongst the parties. If the matter is not resolved by negotiation, the parties will resolve the dispute using the below Alternative Dispute Resolution (ADR) procedure.

Any controversies or disputes arising out of or relating to this Agreement will be submitted to mediation in accordance with any statutory rules of mediation. If mediation is not successful in resolving the entire dispute or is unavailable, any outstanding issues will be submitted to final and binding arbitration under the rules of the American Arbitration Association. The arbitrator's award will be final, and judgment may be entered upon it by any court having proper jurisdiction.

I HAVE READ THIS DOCUMENT AND UNDERSTAND IT. I FURTHER UNDERSTAND THAT BY ACCEPTING THIS RELEASE, I VOLUNTARILY SURRENDER CERTAIN LEGAL RIGHTS.


First Participant's Name

First Name*

Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
I certify that I am 18 years of age or older
First Participant's Signature*
Second Participant's Name

First Name*

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Last Name*
Tenth Participant's Date of Birth*
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Emergency Contact

First Name*

Last Name*

Emergency Contact's Phone Number*
10. EMERGENCY CONTACT.

In case of an emergency, please call


Name: *

Relationship: *

Phone (Day): *

Phone (Evening): *
PARENT/GUARDIAN WAIVER FOR MINORS In the event that the participant is under the age of consent (18 years of age), then this release must be signed by a parent or guardian, as follows: I hereby certify that I am the parent or guardian of minor(s), named above, and do hereby give my consent without reservation to the foregoing on behalf of this individual.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Relationship*

Phone*
Parent or Guardian's Age Acknowledgment*
Parent or Guardian's Date of Birth*
I certify that I am 18 years of age or older
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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