ON BEHALF OF MYSELF, MY SPOUSE, CHILDREN (INCLUDING ANY OF WHICH I AM GUARDIAN), HEIRS, PERSONAL REPRESENTATIVES, EXECUTORS AND ASSIGNS AND ANYONE CLAIMING BY OR THROUGH ME OR ANY OF THE FOREGOING (“RELEASORS”), I HEREBY VOLUNTARILY AGREE TO RELEASE, WAIVE, DISCHARGE, HOLD HARMLESS, DEFEND AND INDEMNIFY THE INFINITY HEALING, INFINITY, INC AND MARYELLEN AMMONS ENTITIES AND THEIR RESPECTIVE PREDECESSORS, SUCCESSORS, AFFILIATES, MEMBERS, OFFICERS, MANAGERS, DIRECTORS, OWNERS, SERVANTS, AGENTS, EMPLOYEES, INSURERS, ATTORNEYS AND VOLUNTEERS (HEREINAFTER REFERRED TO AS “RELEASEES”) FROM ANY AND ALL CLAIMS, DEMANDS, LIABILITIES, LOSSES, INJURIES, PERSONAL INJURIES, PROPERTY DAMAGE, WRONGFUL DEATH, LOSS OF SERVICES, DAMAGES, ACTIONS OR CAUSES OF ACTION, PRESENT OR FUTURE, WHATSOEVER ARISING OUT OF OR CONNECTED WITH THE ACTIVITIES, EQUIPMENT, PRODUCTS OR SERVICES OWNED, OFFERED OR PROVIDED BY OR THROUGH INFINITY HEALING, AND ANY EQUIPMENT, MACHINERY AND/OR FACILITIES OF ANY OF THE RELEASEES, EVEN IF CAUSED IN WHOLE OR IN PART BY THE NEGLIGENCE OF ANY OF THE RELEASEES. I HAVE READ, UNDERSTAND AND VOLUNTARILY SIGN THIS DOCUMENT (INCLUDING THE WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT SET FORTH ABOVE) AND KNOWINGLY WAIVE ANY RIGHTS AGAINST, AND RELEASE THE RELEASEES FROM, ANY SUCH CLAIMS, DEMANDS, INJURIES, PERSONAL INJURIES, PROPERTY DAMAGE, WRONGFUL DEATH, LOSS OF SERVICES, DAMAGES, ACTIONS AND CAUSES OF ACTION. IT IS MY EXPRESS INTENTION TO EXEMPT AND RELIEVE THE RELEASEES FROM ALL LIABILITY FOR PERSONAL INJURY, PROPERTY DAMAGE OR WRONGFUL DEATH. I hereby confirm that no warranty or guarantee, or other assurance, has been made to me covering the results of any of the services, products or equipment offered for use by Infinity Healing, Infinity, Inc., Maryellen Ammons. or any of the RELEASEES 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 and/or obtain services from Infinity Healing, Infinity, Inc. and Maryellen Ammons. I am fully aware of the risks and hazards connected with the use of the equipment and the services, including the risk of physical injury or disability as the result of such injury, and I am voluntarily participating in said equipment usage and the receipt of any services, and entering the above-named premises relating thereto. I 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. I certify that I am financially capable and fully liable for payment of all services and therapies provided at Infinity, Inc., including all retreats, memberships and programs. I understand that this document, including the Waiver of Liability and Hold Harmless Agreement, shall be construed in accordance with the laws of the State of MARYLAND. If any provision of this document is held to be unenforceable, this document shall be considered divisible and such provision shall be deemed inoperative to the extent it is deemed unenforceable, and in all other respects this document shall remain in full force and effect; provided, however, that if any such provision may be made enforceable by limitation thereof, then such provision shall be deemed to be so limited and shall be enforceable to the maximum extent permitted by law. I understand that the RELEASEES will not be responsible for any medical costs associated with any injury. I understand that all therapies provided by Infinity Healing, Infinity, Inc. and Maryellen Ammons (Whole Body Cryotherapy, PBM/NovoTHOR, Floatation Therapy, HUSO, Transformational Healing) are provided for the basic purpose of relaxation, stress reduction, and relief. I understand that these are supportive therapies and not medical treatment. I further understand that any therapy provided by Infinity Healing, Infinity, Inc. and Maryellen Ammons should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician or other qualified medical specialist for any mental or physical ailment. I understand that Infinity Healing staff are not qualified to perform skeletal adjustments, diagnose and/or prescribe, and that nothing said in the course of the session should be construed as such. Because the supportive therapies offered by Infinity Healing, Infinity, Inc. and Maryellen Ammons are 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 staff updated as to any changes in my medical profile and understand that there shall be no liability on any RELEASEES’ part should I forget to do so. I have read the instructions for proper use of the facilities and equipment 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 and equipment. One of the goals of Infinity Healing, Infinity, Inc. and Maryellen Ammons is to collect aggregate data on these supportive therapies to help further research to support optimized health and wellness. I acknowledge that I have been informed and understand that data collection on the use of all of these supportive therapies may be performed and I explicitly provide my consent that my results may be shared for said research and presentation purposes. My signature below constitutes my acknowledgment that (1) I have read, understand, and fully agree to all of the foregoing, (2) the supportive therapy chosen by me 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 any equipment or obtain any products or services at any facility utilized by any of the Infinity Healing, Infinity, Inc. and Maryellen Ammons entities. IN SIGNING THIS DOCUMENT, I ACKNOWLEDGE AND REPRESENT THAT I HAVE READ AND UNDERSTAND THIS DOCUMENT, INCLUDING THE WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT, I AM AT LEAST EIGHTEEN (18) YEARS OF AGE AND FULLY COMPETENT; I HAVE GIVEN UP CONSIDERABLE FUTURE LEGAL RIGHTS; AND I EXECUTE THIS DOCUMENT 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 ALL OTHER EQUIPMENT AND THAT I AM USING SUCH EQUIPMENT AND OBTAINING ANY 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. ALL SALES ARE FINAL, NON-TRANSFERABLE AND NON-REFUNDABLE. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 SAFETY INSTRUCTIONS AND CONTRAINDICATIONS Mandatory Safety Instructions for Whole Body Cryotherapy Systolic blood pressure must not exceed 159 mmHg at the time of service, per manufacturer recommendation. You must wear cotton or wool socks (and underwear for men) to minimize the potential of chilblain and other potential injuries from overexposure to cold temperatures. Sessions are limited to 3 minutes per session to minimize the potential for such adverse effects from overexposure to cold temperatures. During the session, you must ensure that your head remains above the level of, and avoid inhaling, gasiform air (the cloudy gas circulating in the cryochamber); while non-toxic, it is devoid of oxygen and may cause shortness of breath, fainting, or other conditions. You must immediately notify the attendant and end the session if you at any time experience any physical or mental discomfort, problems, pain or anxiety. Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, lotions, piercings, or medication, including but not limited to, tranquilizers and high blood pressure medication – do not use WBC if you have reason to believe you have come in contact with or ingested any such product. A person who is less than (18) years of age may not use whole body cryotherapy without written parental consent. A person who is less than (14) years of age may not use whole body cryotherapy even with parental consent. Whole Body Cryotherapy Contraindications Do not use whole body cryotherapy if you have or may have any of the following conditions: Pregnancy, Hypertension, 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 18 years (parental consent to session needed), acute kidney and urinary tract diseases. If you have any other injury, illness or medical condition, you should consult your physician prior to using cryotherapy. Risks of whole body cryotherapy include, but are not limited to: fluctuations in blood pressure (due to peripheral vasoconstriction, systolic blood pressure may briefly increase by up to 10 points during the session. This effect should reverse after the end of the session, 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. One primary inherent risk of cryotherapy is skin sensitivity and skin irritation. It is impossible to predict how client’s skin will react during or after cryotherapy. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 Mandatory Safety Instructions for NovoTHOR: Lotions, powder, deodorant, antiperspirant, perfume, makeup or anything topical on the body may reduce benefit. It is recommended these items are not used within 1 hour prior to session. You must inform attendant if you have any recent skin lesions. For the protection of all NovoTHOR users, all lesions must be covered with an adhesive bandage. Approved Safety eyewear are provided by Infinity Healing for protection during session. Disrobe to level of comfort, however light cannot penetrate clothing so it is optimal for no clothing to be worn; No cell phone use during NovoTHOR session. You will lie on the bed face up for the duration of the session. Sessions are 5 minutes to 12 minutes in length per session. Session not to exceed 12 minutes to minimize the potential for adverse or minimized effects from overexposure to NovoTHOR. The length of the session is at the sole discretion of the Infinity staff member. When the session is complete, the unit will turn off automatically. At this time, please exit the bed and get dressed. You must immediately notify the attendant and end the session if you at any time experience any physical or mental discomfort, problems, pain or anxiety; A person who is less than (18) years of age may not use NovoTHOR without written parental consent. NovoTHOR Contraindications Do not use NovoTHOR if you have or may have any of the following conditions: Pregnancy, Light Sensitivity, Epilepsy, or known Cancer (primary carcinoma/secondary metastasis). If undergoing Chemotherapy, consult your oncologist. For diabetic clients, use of NovoTHOR may influence medication dosage requirements. Blood sugar should be monitored throughout treatment. If you have any other injury, illness or medical condition, you should consult your physician prior to using NovoTHOR. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 Aspen Laser The Aspen Laser is a wellness tool that uses Photobiomodulation to reduce/eliminate pain and to control pain. It is not intended to be used as a medical device or replace proper medical care or evaluation. Each session is approximately 10 minutes (2.5 minutes per application). You will remain clothed and you must immediately notify the attendant and end the session if you at any time experience any physical or mental discomfort, problems, pain or anxiety. Do not use the Aspen Laser if you have or may have any of the following conditions: Pregnancy, Light Sensitivity, Epilepsy, or known Cancer (primary carcinoma/secondary metastasis). If undergoing Chemotherapy, consult your oncologist. Float Room Therapy I hereby confirm that I am using the flotation facilities at my own risk. I further understand that while using the facilities I could fall due to slippery surfaces resulting in severe injury. I hereby confirm and understand that Flotation Therapy can cause intense relaxation and it could influence motor skills and the ability to drive heavy machinery. Upon exiting the Float Therapy Spa, I take all responsibility for my actions. I am not taking prescription medication or have consulted my doctor about Flotation Therapy and understand all associated risks in combination with my medication. I am not wearing a pacemaker and do not have any serious heart disease. I do not suffer from epilepsy, psychotic attacks, respiratory, kidney or communicable disease. In rare cases Flotation causes nausea, vomiting, dizziness and rashes. These could be signs of a Kidney disorder and an inability to process magnesium. Should these symptoms occur please stop use of the Flotation Spa and consult your doctor. I am not under the influence of drugs, alcohol or illegal substances. I have no history of ear infections or have spoken to my doctor about Flotation Therapy and understand all associated risks. I understand the Flotation Spa could cause drowning or injury. I will pay a salt replacement and cleaning fee of $1500.00 on the day of incident should I voluntarily or involuntarily have a bowel movement, urinate or discharge any other fluid in the Float Spa or skip the shower before entry into float spa. (All of these are easily detectable by trained staff) I understand that the basic purpose of the Flotation Spa is to provide relaxation and relief from muscular tension and stress. I also understand that researchers and regular floaters have reported many other mental and physical benefits and effects received from floating, and that the flotation experience is uniquely individual. People are different and their flotation experiences will also be different. Infinity Healing, Infinity, Inc. and Maryellen Ammons, their employees and their staff, make no claim or guarantee of any particular benefit or effect, that may be the result of the use of these flotation facilities. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 HUSO Consent And Disclaimer Form HUSO sound frequency is an alternative and complementary medicine experience that was designed to balance the autonomic nervous system and recalibrate the electromagnetic field of the body. Although HUSO has shown promising results, it has not been researched by the Western academic, medical, and psychological communities, and thus it is considered experimental with the extent of effectiveness as well as the risks and benefits not fully known. It is not intended to treat or diagnose any health problem or disease and it is not a substitute for professional care. We strongly suggest that you seek professional advice before making any health decision. If you have a history of seizures, have a cardiac pacemaker or implanted electrical device or have a traumatic brain injury in the last 6 months, or you or your child have been diagnosed with autistic spectrum disorder, these are contraindicated and you cannot run on HUSO. By running a session or a continuing program on HUSO, you agree to forever fully release and hold harmless, Infinity Healing, Infinity, Inc. and Maryellen Ammons its owners, members, officers, employees, agents, consultants, volunteers, and others associated with Infinity Healing, Infinity, Inc. and Maryellen Ammons, from any claim or liability of whatsoever kind or nature which you may incur arising at any time out of or relation to your participation in this program. If any court of law rules that any part of the Disclaimer is invalid, the Disclaimer stands as if those parts were struck out. Further it is agreed: Before receiving a HUSO session, I acknowledge that I have read and/or listened to and understand the information provided to me, that I have had all of my questions answered to my satisfaction, and that my participation is entirely voluntary. I acknowledge that I have been informed and understand that research testing in conjunction with use of HUSO may be performed and I explicitly provide my consent that my medical information and results may be shared for said research purposes. I also acknowledge that no guarantees were made to me regarding the effectiveness of a HUSO session and though unlikely, there could be some adverse reactions or temporary discomfort with the HUSO session. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 Transformational Healing Sessions Maryellen Ammons is an ordained minister through the Universal Life Church and these transformational healing sessions are fully ordered under the authority of God and Jesus Christ as the healer. She is a Prophet (Ezekiel 3:17), has the gift of miracles (1 Corinthians 12), she prays into the Courts of Heaven and can read your Book of Life. All healing is done by YahWeh and therefore is done in God's Will and God's Way, to include God's timing. For the healing to occur, the client must be called by God to need a session, and have faith, obedience and trust in the Lord. Participant/Legal Guardian Signature: Signature Date: October 30, 2024 Disclaimer The information provided here is for educational, purposes only. It is not intended to be a substitute for medical advice, diagnosis or treatment. I am not a Medical Doctor, Mental Health Provider, Registered Dietitian or Nutritionist. My intent is NOT to replace any relationship that exists, or should exist, between your Medical Provider or Mental Health Provider. Please consult with your doctor or provider if you have any questions regarding my services, and then make your own well informed decisions based upon your needs and goals. As a transformational healer, I support you as a guide to help you achieve your goals. You acknowledge my role to provide you with ongoing support and accountability as we work together in reaching and maintaining your health goals. The intent is to educate, inform and empower you as you begin and continue your journey to a healthier you. I received my training from the Institute of Integrative Nutrition and SUNY College in New York. I studied over 100 diet theories, realistic approaches to lifestyle adjustments and inspiring coaching methods with some of the world’s top health and wellness experts. These include Dr. Deepak Chopra, Dr. Mark Hyman, Dr. Andrew Weil, Dr. T. Colin Campell and many more authorities in the energy medicine field. Not Evaluated by FDA The information provided in this website’s copy, blogs, emails, services, programs, and supportive therapies provided by Infinity Healing, Infinity, Inc. and Maryellen Ammons has not been evaluated by the Federal Drug Administration, and in no way meant to cure, treat, diagnose, or prevent any diseases, or be considered a substitute for medical or psychological advice.
Participant/Legal Guardian Signature: Signature Date: October 30, 2024 Photo Consent and Release Form Without expectation of compensation or other remuneration, now or in the future, I hereby give my consent to Infinity Healing, Infinity, Inc. and Maryellen Ammons, its affiliates and agents, to use my image and likeness and/or any interview statements from me in its publications, advertising or other media activities (including the Internet). This consent includes, but is not limited to: (a) Permission to interview, film, photograph, tape, or otherwise make a video reproduction of me and/or record my voice; (b) Permission to use my name; and (c) Permission to use quotes from the interview(s) (or excerpts of such quotes), the film, photograph(s), tape(s) or reproduction(s) of me, and/or recording of my voice, in part or in whole, in its publications, in newspapers, magazines and other print media, on television, radio and electronic media (including the Internet), in theatrical media and/or in mailings for educational and awareness. This consent is given in perpetuity, and does not require prior approval by me. COVID-19 Center Policies We appreciate your patience during these uncertain times. We are a prevention and wellness center, and as such, the comfort and safety of all of our clients is important to us. Masks are optional in the clinic. We space appointments for social distancing purposes, and if you arrive early, please feel free to wait in your car until your appointment time. If you have a fever or cold and flu symptoms, you must notify us via email at contact@infinity.care and have a negative COVID test. Our 24 hour cancellation policy does apply. PFAS Notice and Waiver Due to the high levels of toxins in the SOMD area and nationwide, specifically PFAS (perfluorooctanoic acid (PFOA) and perfluorooctane sulfonic acid (PFOS), our clients often need specific care. SOMD is in a high risk area, therefore we strongly encourage you to educate yourself on this emerging crisis and get a medical examination, which includes a blood and a urine test for PFAS. Communities like Pease Air Force Base are on the cutting edge of the emerging health crisis. At Infinity, we offer an AO Scan, Cell Well Hair analysis and HeartQuest wellness tools for your vibrant wellness. You have a right to use any therapies you have purchased, if you decide to use the therapies without a consultation or testing, you are waiving all legal rights for any reaction that occurs based on your decision to forego the rquired AO Scan testing. Symptoms of PFAS toxicity are liver failure, kidney failure, stomach pain, poor digestion, cancer, asthma and thyroid disease. We have had reports of tendon pain and rupture, joint pain and distended and swollen abdomens. PFAS has been linked in Government and public studies to thyroid disease, increased cholesterol levels, breast cancer, liver damage, kidney cancer, inflammatory bowel disease, testicular cancer, increased time to pregnancy, and pregnancy induced hypertension/pre-eclampsia.
|
