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Float On SNJ LLC Liability Waiver 

Floatation Meditation Therapy provides a deep state of relaxation that stimulates blood flow throughout all of the body's tissues, releases natural endorphins, and the brain gives out alpha and theta waves associated with relaxation and meditation. To ensure a comfortable, clean and safe Meditation Floatation experience, I agree to the following (please initial each statement):

I do not have any communicable or infectious disease, illness, open sore or skin disorder

I do not have a condition nor am I medicated in any manner which may be adversely affected by profound relaxation and/or immersion in concentrated Epsom salt water.
I am not under the influence of any nonprescription medication, drug or alcohol
 I do not have a history of high (>= 180/120) or low (<=90/50) blood pressure
 I am not diabetic with an insulin dependency
I do not have kidney disease or chronic heart disease
I do not suffer from uncontrolled seizures or epilepsy
If I am menstruating, I agree to take the same precautions I would in a public pool 
I have consulted with my physician if I am an 'at-risk' pregnancy 
I will shower before and after my float I understand that the Flotation Tank uses pharmaceutical grade Epsom salts, natural enzymes, non-toxic biodegradable cleaning products, and a small amount of 35% hydrogen peroxide.

I understand I will be in a wet environment and that I will encounter and navigate slippery surfaces. I agree to use caution and take full responsibility for my movements in and around the tank.

I further understand that each individual may have a unique experience. I have been given an orientation which familiarized me with the safe and appropriate use of the tank. I agree to take full responsibility for my thoughts and actions while in and around the floatation and the waiver of liability and all agreements made herein shall apply to each and every use of the flotation tank. I hereby agree to irrevocably release and waive any claims that I have now or may have hereafter against Float On SNJ LLC and its employees and agents. I have read and fully understand and agree to the above terms of this Liability Waiver Agreement. I am signing this agreement voluntarily and recognize that signature serves as complete and unconditional release of all liability to the greatest extent allowed by law in the State of New Jersey.

Dated: December 6, 2019

First Participant's Name

First Name*

Last Name*

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

How did you hear about us?
First Participant's Signature*
Second Participant's Name

First Name*

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

How did you hear about us?
Third Participant's Name

First Name*

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

How did you hear about us?
Fourth Participant's Name

First Name*

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

How did you hear about us?
Fifth Participant's Name

First Name*

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

How did you hear about us?
Sixth Participant's Name

First Name*

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

How did you hear about us?
Seventh Participant's Name

First Name*

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

How did you hear about us?
Eighth Participant's Name

First Name*

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

How did you hear about us?
Ninth Participant's Name

First Name*

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

How did you hear about us?
Tenth Participant's Name

First Name*

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

How did you hear about us?
Participant'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.
Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
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.
Parent or Guardian's Name

First Name*

Last Name*

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

How did you hear about us?
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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