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Cryotherapy Waiver

Whole Body Cryotherapy is the exposure of a person's skin to temperatures of -110 to -150 degrees Celsius (-166 to -238 degrees Fahrenheit) for a short time (3 minutes or less). At this extreme temperature, the body activates several mechanisms that have significant long-term medical, health and cosmetic benefits.

Skin: The outer skin is briefly "frozen", activating increased production of collagen in deeper layers of the skin (similar to laser treatments of the face where very high temperatures are used). The skin regains elasticity and becomes smoother and more even-toned, significantly improving conditions such as cellulite and skin aging. Skin vessels and capillaries undergo severe vasoconstriction, or narrowing of the blood vessels, to keep the core temperature from dropping, followed by vasodilation, or widening of the blood vessels, after the procedure. Toxins and other stored deposits are flushed out of the layers of the skin, and the body's ability to deliver blood to its biological tissue is improved after several treatments. The anti-inflammatory properties of cryotherapy also treat chronic skin conditions such as psoriasis and dermatitis.

Endocrine System: The extreme cold exposure of cryotherapy causes the body to increase its metabolic rate in order to produce heat. This effect lasts for 5-8 hours after the procedure, causing the body to burn 400-800 calories during the hours following the procedure. After several procedures, the increase in metabolic rate tends to last longer between treatments. Another survival reaction to the extreme temperatures is the release of endorphins (hormones) that have analgesic and anti-inflammatory properties and improve mood disorders. Cryotherapy has been studied for the successful treatment of medication-resistant depressive disorders. Furthermore, some patients experience a noticeable increase in libido, lending to the use of cryotherapy for ED and other sexual disorders.

Musculoskeletal: The anti-inflammatory and analgesic properties of cryotherapy can drastically improve joint disorders such as rheumatoid and osteoarthritis. Athletes use cryotherapy to recover from injuries and improve their performance.

Immune System: Cryotherapy improves the function of the immune system and decreases stress levels.

YOU SHOULD NOT USE WHOLE BODY CRYOTHERAPY IF YOU ARE/HAVE: Pregnant; have severe Hypertension (Blood Pressure greater than 180/100); acute or recent Myocardial Infarction (heart attack; not cleared for exercise); Arrhythmia; Symptomatic CardiovascularDisease; acute or recent Cerebrovascular Accident (stroke; not cleared for exercise); uncontrolled Seizures; Fever; Symptomatic Lung Disorders; Bleeding Disorders; Infection; Claustrophobia; Intolerance to Cold; Age less than 18 years (parental consent to treatment needed for minors) or Incontinence.

Safety Instructions for Whole Body Cryotherapy:

1. You must wear cotton or wool socks on the hands and feet (and underwear or additional undergarments for men) to avoid chilblain (painful itching & swelling of the skin due to exposure to cold temperatures).
2. Treatments are limited to 3 minutes per session. Overexposure to the cold temperatures may cause chilblain.
3. During treatment, you must avoid inhaling the nitrogen fumes; while non-toxic, they are devoid of oxygen and may cause fainting.
4. You may end the procedure at any time if you experience any problems or anxiety.
5. Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, or medication, including but not limited to: Tranquilizers and High Blood Pressure Medication;
6. If you are younger than 18 years old, you may only use whole body cryotherapy WITH PARENTAL CONSENT.
7. If you have experienced a heart attack, stroke or other cardiac or medical condition, YOU MUST BE CLEARED FOR EXERCISE BY YOUR TREATING PHYSICIAN.

Risks of Whole Body Cryotherapy:
Fluctuations in Blood Pressure can occur due to peripheral vasoconstriction, and blood pressure may briefly increase by 10 to 20 points systolically during treatment. This effect should reverse after the end of the procedure, as peripheral circulation returns to normal. Also, Allergic Reaction to extreme cold (rare), Claustrophobia, Anxiety, Activation of some Viral Conditions (cold sores) etc. due to stimulation of the immune system may occur.

WAIVER OF LIABILITY AND RELEASE

1. In consideration for undergoing Whole Body Cryotherapy and for use of the cryotherapy device (Equipment), I, the undersigned, for myself, my heirs, executors, administrators and assigns, hereby RELEASE, WAIVE, DISCHARGE, and HOLD HARMLESS Relany LLC and CryoFit Americas, Inc., (hereinafter referred to as Releasees) and their respective employees, representatives, designees, members, managers, agents, officers, and boards of Releasees, and the successors and assigns of any of them, (hereinafter jointly referred to as Agent), without limitation, from any and all liability, claims, demands, and causes of action whatsoever arising out of, related to or connected in any way with me entering the CryoFit premises, my participation in Whole Body Cryotherapy, from the use of the Equipment or due to the use of the Equipment on me any of which may cause damage or injury to me, whether caused by the negligence of Releasee and its Agent or carelessness or otherwise.

2. My participation in Whole Body Cryotherapy is VOLUNTARY and DONE AT MY OWN RISK. I hereby confirm that no warranty, guarantee, or other assurance has been made to me by Releasee or its Agent covering the results of the cryotherapy process, which has been explained to me. I understand the administration of cryotherapy, including possible adverse reactions, side effects, or other possible complications from it. I understand, consent, and agree to assume those risks in advance of any Whole Body Cryotherapy, from the use of the Equipment or use of the Equipment on me or from entering the CryoFit premises to engage in such usage.

3. I AGREE TO INDEMNIFY, HOLD HARMLESS AND RELEASE the Releasees and its Agents, who through negligence or carelessness or otherwise, might by liable to me (or my heirs, personal representatives or assigns) for damages that may occur due to my participation in Whole Body Cryotherapy, from the use of the Equipment or due to the use of the Equipment on me or from me entering the CryoFit premises to engage in such usage.

4. I AGREE that this Waiver of Liability and Release shall be construed under the laws of the State of Wisconsin.

5. I understand that Whole Body Cryotherapy and the Equipment used in cryotherapy is designed for fitness and appearance enhancing use ONLY by persons in good general health. I have been advised that if I suffer from any medical condition or illness whatsoever, I am NOT TO USE the Equipment or undergo Whole Body Cryotherapy without my doctors written permission.

I ACKNOWLEDGE AND REPRESENT that (1) I have read, understand, and fully agree to the foregoing WAIVER OF LIABILITY AND RELEASE, (2) the proposed cryotherapy process has been satisfactorily explained to me and I have all of the information I desire, (3) I have had a previous medical examination to assure myself and assume my own responsibility of physical fitness and capability to undergo cryotherapy, and (4) I hereby give my authorization and consent. This WAIVER OF LIABILITY AND RELEASE is effective as long as I undergo cryotherapy and use the Equipment at the location now and in the future. No oral representations, statements or inducements apart from the foregoing written agreement have been made by Releasee and its Agent; I am at least 18 years old and fully competent; and I agree that I will comply with all instructions on the use of the Equipment. 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.

Date: September 16, 2021

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First Participant's Name

First Name*

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
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*
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Emergency Contact

Emergency Contact's Name*

Emergency Contact's Phone Number*
Severe Cardiovascular Conditions
Do you have Untreated Hypertension?*
No
Yes
Do you have Peripheral Arterial Occlusive Disease?*
No
Yes
Have you had a Heart Attack within the previous 6 months?*
No
Yes
Do you have Valvular heart disease?*
No
Yes
Do you have Unstable Angina Pectoris?*
No
Yes
Do you have Ischemic heart disease?*
No
Yes
Do you have a Pacemaker or AICD?*
No
Yes
Do you have any other heart condition?*
No
Yes
Do you have Decompensating diseases (edema) of the cardiovascular and respiratory system, congestive heart failure, COPD or chonic liver disease?*
No
Yes
Circulatory/Skin Conditions
Do you have Deep Vein Thrombosis (DVT) or known circulatory dysfunction?*
No
Yes
Do you have Raynaud's disease?*
No
Yes
Do you have Bacterial or Viral infections of the skin, wound healing disorders (open sores or discharging wound/skin conditions)?*
No
Yes
Do you have Vasculitis?*
No
Yes
Blood Disorders
Do you have Severe Anemia?*
No
Yes
Do you have Heavy consumerist diseases (abnormal bleeding)?*
No
Yes
Conditions of the Nervous System/Kidney & Liver function
Do you have Diabetes?*
No
Yes
Do you have any Seizure disorders?*
No
Yes
Do you have Hyperhidrosis (heavy perspiration)?*
No
Yes
Do you have Polyneuropathies? Polyneuropathy is the simultaneous malfunction of many peripheral nerves throughout the body.*
No
Yes
Other General Health Conditions
Do you have acute febrile respiratory (Flu-like respiratory) conditions?*
No
Yes
Are you Claustrophobic?*
No
Yes
Do you have Cold Allergenic Phenomenon (known allergy to cold contactants)?*
No
Yes
Do you have any Alcohol or drug-related contraindications?*
No
Yes
Are you Pregnant or do you think you might be Pregnant?*
No
Yes
Do you feel healthy and well at this moment?*
No
Yes
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*

Relationship*

Phone*
Parent or Guardian's Date of Birth*
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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