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PACIFICRYO CRYOTHERAPY AND NORMATEC RECOVERY WAIVER OF LIABILITY, ASSUMPTION OF RISKS, INDEMNITY AGREEMENT AND CONSENT FORM

Whole Body Cryotherapy

Whole body cyotherapy is the exposure of a person's skin to temperatures of - 238 to -274 degrees Fahrenheit for a short time (3 minutes or less). At this extreme temperature, the body activates several mechanisms that may have significant long-term health and cosmetic benefits including but not limited to caloric burning, weight loss, detox, relieve muscle soreness and pain, rejuvenate mind and body.


Safety Instructions for Whole Body Cryotherapy:

Wool socks and gloves will be provided for you to wear during your session.
Men MUST wear underwear or shorts during a session.
For women, clothing is optional. If wearing clothing, you must refrain from wearing anything with a metal clasp or buckle.
Treatments are limited to 3 minutes per session. Overexposure to the cold temperatures may cause frostbite.
During treatment, you must avoid inhaling the nitrogen fumes; while non-toxic, they are devoid of oxygen and may cause fainting.
You may end the procedure at any time if you experience any problems or anxiety.
Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, or medication, including but not limited to the following: Tranquilizers, High blood pressure medication.
A person who is less than (18) years of age may not use whole body cryotherapy without parental consent.

Contraindications to using Whole Body Cryotherapy: (You must initial this section)

Pregnancy, severe hypertension (BP> 170/100), acute or recent myocardial infarction, unstable angina pectoris, arrhythmia, symptomatic cardiovascular disease, cardiac pacemaker, peripheral arterial occlusive disease, venous thrombosis, acute or recent cerebrovascular accident, uncontrolled seizures, Raynaud's Syndrome, fever, tumor disease, symptomatic lung disorders, bleeding disorders, severe anemia, infection, claustrophobia, cold allergy, age less than 14 years (parental consent to treatment needed for anyone under 18 years old), acute kidney, urinary tract diseases, and bodyweight over 300 lbs.

Initial below to indicate that you have read through these contraindications carefully.

ASSUMPTION OF RISKS.I understand that there are potential risks and dangers which may arise in my use and participation in the Equipment.Fluctuations in blood pressure (due to peripheral vasoconstriction, blood pressure may briefly increase by up to 10 points systolically during treatment. This effect should reverse after the end of the procedure, as peripheral circulation returns to normal), Allergic reaction to extreme cold (rare), claustrophobia, anxiety, activation of some viral conditions (cold sores) etc. due to stimulation of the immune system. Other risks may include but are not limited to skin damage, nerve damage, frostbite, wrist, ankle, shoulder, back injury, hand amputation, foot amputation, loss of limbs, complex regional pain syndrome, reflex sympathetic dystrophy. I understand that these injuries and losses might result not only from my actions, but also from the actions, inaction, or negligence of others. I understand and appreciate these and all other risks in the use of cryotherapy. Despite the potential risks and damages associated with the use of cyrotherapy, I voluntarily wish to proceed and I voluntarily and freely accept and expressly assume all risks and damages whatever they may be from the use of cryotherapy that could result in personal injuries and property damages to me. I have NOT had previous injuries as listed above.I KNOWINGLY AND VOLUNTARILY ASSUME ALL SUCH RISKS, ALL KNOWN AND UNKNOWN, EVEN IF ARISING FROM THE NEGLIGENCE OF RELEASEES, and assume full responsibility for my participation in the use of the Equipment.

RELEASE AND WAIVER OF LIABILITY

1. In consideration for using the cryo device (Equipment), I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents and assigns,HEREBY RELEASE,WAIVE, DISCHARGE, COVENANT NOT TO SUE, AND HOLD HARMLESS PACIFICRYO, its officers, servants, agents, employees and volunteers (hereinafter referred to as RELEASEES) from any and all liability, including any and all claims, demands, actions, causes of action (known or unknown), suits, or judgments of any and every kind (including attorneys' fees), arising from any injury, property damage or death that I may suffer as a result of my participation in the Equipment, REGARDLESS OF WHETHER THE INJURY, DAMAGE, OR DEATH IS CAUSED BY THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE.

2. I hereby confirm that no warranty or guarantee, or other assurance, has been made to me covering the results of the cryo process, and I hereby relieve them and hold them harmless from all liabilities for injury or damage that may occur to me. I fully understand the administration of the process, including possible adverse reactions, side effects, or other possible complications. It is understood that this CONSENT is being given in advance of any administration of the process, and is being given by me voluntarily to use the Equipment.

3. I am fully aware of the risks and hazards connected with the use of the Equipment, including the risk of physical injury or disability as the result of such injury, and I am voluntarily participating in said Equipment usage, and entering the above named premise to engage in such usage. I KNOWINGLY VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS OF LOSS, PROPERTY DAMAGE OR PERSONAL INJURY that may be sustained, or any loss or damage to property as a result of being engaged in such an activity.

4. I, on behalf of myself, my personal representatives, heirs, executors, administrators, agents and assigns, further hereby AGREE TO INDEMNIFY AND HOLD HARMLESS the RELEASEES from and any and all losses, damages, claims, actions, suits, procedures, costs, damages and liabilities, including attorney's fees and costs, which occur as a direct or indirect result of my involvement in the use of the Equipment, and agree to reimburse the RELEASESS for any and all such expenses.

5.It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and spouse (if any), if I am alive, and my heirs, assignees and personal representative, if I am not alive, and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE of the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of California.

6. I agree that this Agreement is intended to be as broad and inclusive as is permitted by law and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.

7. I understand that Whole Body Cryotherapy is intended and provided for the basic purpose of calorie burning, weight loss, relaxation, stress reduction, relief of muscular tension, recovery from muscular tension, and recovery from surgery, illness or injury. I further understand that Whole Body Cryotherapyshould not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor, or other qualified medical specialist for any mental or physical ailment prior to using the Equipment.

8. I understand that Whole Body Cryotherapy therapists are not medical professionals and thereforenot qualified to perform skeletal adjustments, diagnose and/or prescribe, and that nothing said in the course of the session should be construed as such.

9. Because Whole Body Cryotherapy is contraindicated under certain conditions, I affirm that I have stated all my known medical conditions and answered all questions honestly. I agree to keep the therapist updated as to any changes in my medical profile and understand that there shall be no liability on the therapist's part should I forget to do so.

My signature below constitutes my acknowledgment that (1) I have read, understand, and fully agree to the foregoing CONSENT, (2) the proposed indoor cryo process has been satisfactorily explained to me and I have all of the information I desire and (3) I hereby give my authorization and consent. This CONSENT shall stand as long as I use the Equipment at the location now and in the future.

I have read the instructions for proper use of the facilities and do so at my own risk and hereby release the owners, operators, franchisers, or manufacturers, from any damage or harm that I might incur due to use of the facilities.

IN SIGNING THIS RELEASE, I ACKNOWLEDGE AND REPRESENT THAT:

I have read and understand the foregoing Waiver of Liability and Hold Harmless Agreement.
I understand that Pacificryo in its sole discretion can refuse service to me for any reason including my own personal safety or the safety of itself or any of its employees.
I am at least eighteen (18) years of age and fully competent.
I have given up considerable future legal rights.
I certify that I do NOT suffer from any of the contraindications listed above.
And I execute this Release freely, voluntarily, under no duress or threat of duress, without inducement, promise or guarantee being communicated to me.

Furthermore, I agree that I will comply with all instructions on the use of the cryo device and that I am using these services at my own risk. I agree to use all sessions within the terms of the contract dates and understand that refunds are not given on unused portions of purchased packages.

NORMATEC ROCOVERY SYSTEM

The NormaTec PULSE Recovery System is best pneumatic compression system on the market for passive recovery. It does all the work while you relax in our anti-gravity chairs after your workouts.

Studies have shown that 20 minutes of rest in the NormaTec boots is equivalent to performing active recovery workouts in reducing delayed onset muscle soreness (DOMS) and in improving performance in subsequent workout sessions. It has multiple settings you can use depending on your individual preference and workout intensities. It is a 20 minute post workout massage without the cost, oils, and appointments. 

Possible associated risks may include but are not limited to: cut off of circulation due to pressure, contusion/bruising. Other extreme causes include but are not limited to the risks identified in the Cyrotherapy Assumption of Risks described above and herein including but not limited to blood clots, heart attack, stroke, and/or death.  

Photographs

I agree to the use of my name, age, likeness, photographs, school/occupation/affiliation, testimonials, reasons for use of therapy and other related items without compensation, unless I, in writing, separate and apart from this Agreement, expressly provide written declination to non-use otherwise. 


Thanks,
Erik Meaders
Business Manager
Pacificryo
909-375-1333
info@Pacificryo.net
www.Pacificryo.net
 

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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.
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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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