Loading...

Chill Cryotherapy llc

Whole Body Cryotherapy User Agreement

PLEASE READ CAREFULLY BEFORE SIGNING

Today's Date: November 14, 2024

BY SIGNING BELOW YOU CONFIRM THAT YOU HAVE CAREFULLY READ BOTH PAGES OF THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS, VOLUNTARILY AGREE TO EACH OF ITS TERMS AND PROVISIONS, AND SIGN OF YOUR OWN FREE WILL

Agreements:

1. Follow all instructions given to you by the attendant.

2. Participation in a whole body cryotherapy session involves exposure to extreme cold temperature for a short period of time (not to exceed three (3) minutes per session). By signing this agreement you confirm that you are in good health and do not have any of the contraindications identified above or other physical condition that would preclude you from safely using whole body cryotherapy.

3. If you experience any pain or mental or physical discomfort at any time during the process, you may terminate the session immediately. The chamber will not be locked, and you are free to walk out of the chamber at any time.

4. No representations or claims are made as to the therapeutic nature or other benefits of whole body cryotherapy. Whole body cryotherapy is not intended to diagnose, treat, cure or prevent diseases, illnesses, imbalances or disorders. No results from whole body cryotherapy are assured. Every customer is different and responds differently to the therapy.

Waiver and Release:

1. This is a release of liability and a waiver of certain legal rights.

2. By signing this agreement you:

i. acknowledge that use of whole body cryotherapy involves risk of bodily injury, illness, disability or death, which may be compounded by negligent emergency response of the attendant. You acknowledge that you are voluntarily participating in whole body cryotherapy with knowledge of the dangers involved and accept and assume all risks of injury, illness, disability or death, whether caused by the condition of the facilities or equipment or the negligence of the attendant or otherwise. You acknowledge that frostbite is a specific risk that you assume.



ii. expressly waive and release any and all claims against Chill Cryotherapy llc., and its members, directors, employees, agents, affiliates, successors and assigns (which are collectively referred to as "the Company"), arising out of or attributable to your use of whole body cryotherapy, other than as may arise from the gross negligence or intentional misconduct of the Company. You covenant not to assert any such claims against the Company, and forever release and discharge the Company from liability for such claims.
iii. indemnify and hold harmless the Company from any loss, liability, damage, cost or expense arising out of or connected in any manner with your use of whole body cryotherapy, except as may arise from the gross negligence or willful misconduct of the Company.
iv. agree that this waiver and release is intended to be as broad and inclusive as permitted under law. You specifically acknowledge and agree that this agreement is not intended to be a general release subject to limitations and conditions that would otherwise apply under applicable state law and additionally agree to waive all general release limitations provided by applicable law.

General Provisions:

1. This agreement shall be construed and interpreted as broadly as possible under the applicable law of the jurisdiction in which you use whole body cryotherapy, with the words, terms, provisions, covenants, and remedies contained in this Agreement to be enforceable to the fullest extent permitted by applicable law.

2. If any portion of this Agreement is held invalid, the remainder shall not be affected and shall continue in full legal force and effect.

3. The terms of this Agreement shall continue from this date forever and shall apply to each use by you of whole body cryotherapy without the need for you to resign this Agreement.

4. This document constitutes the entire agreement regarding your use of whole body cryotherapy and supersedes all prior discussions and representations about the use, benefits or risks of whole body cryotherapy.

 

First Customer's Name

First Name*

Last Name*

Phone*
First Customer's Date of Birth*
First Customer's Information

FOR MINORS ONLY:


Emergency Contact
First Customer's Signature*
Second Customer's Name

First Name*

Last Name*
Second Customer's Date of Birth*
Second Customer's Information

FOR MINORS ONLY:


Emergency Contact
Third Customer's Name

First Name*

Last Name*
Third Customer's Date of Birth*
Third Customer's Information

FOR MINORS ONLY:


Emergency Contact
Fourth Customer's Name

First Name*

Last Name*
Fourth Customer's Date of Birth*
Fourth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Fifth Customer's Name

First Name*

Last Name*
Fifth Customer's Date of Birth*
Fifth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Sixth Customer's Name

First Name*

Last Name*
Sixth Customer's Date of Birth*
Sixth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Seventh Customer's Name

First Name*

Last Name*
Seventh Customer's Date of Birth*
Seventh Customer's Information

FOR MINORS ONLY:


Emergency Contact
Eighth Customer's Name

First Name*

Last Name*
Eighth Customer's Date of Birth*
Eighth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Ninth Customer's Name

First Name*

Last Name*
Ninth Customer's Date of Birth*
Ninth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Tenth Customer's Name

First Name*

Last Name*
Tenth Customer's Date of Birth*
Tenth Customer's Information

FOR MINORS ONLY:


Emergency Contact
Customer's Address
Address Line 1:*
Street address, P.O. box, company name, c/o
Address Line 2:
Apartment, suite, unit, building, floor, etc.
Country:*
City:*
State/Province:*
Zip/Postal:*
Parent or Guardian's Email Address

Email*

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

Do not participate in Whole Body Cryotherapy if you have any of the following conditions:

Untreated Hypertension*
No
Yes
Heart attack within previous 6 months*
No
Yes
Decompensating diseases (edema) of the cardiovascular and respiratory system(COPD);congestive heart failure*
No
Yes
Unstable Angina Pectoris*
No
Yes
Pacemaker*
No
Yes
Peripheral Arterial Occlusive Disease*
No
Yes
Deep Vein Thrombosis (DVT) or known circulatory dysfunction*
No
Yes
Acute febrile respiratory (Flu like respiratory conditions)*
No
Yes
Severe Anemia*
No
Yes
Cold Allergenic Phenomenon (known allergy to cold contactants)*
No
Yes
Bacterial and viral infections of the skin*
No
Yes
Wound healing disorders (open sores or discharging wound/skin conditions)*
No
Yes
Polyneuropathies*
No
Yes
Raynaud's disease*
No
Yes
Pregnancy*
No
Yes
Vasculitis*
No
Yes

You may have other conditions that make whole body cryotherapy inappropriate. Consult with your doctor or medical advisor if you have questions as to whether whole body cryotherapy is right for you.

Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


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*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

FOR MINORS ONLY:


Emergency Contact
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!