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Please take a moment to review the important information within this salt room waiver. 

In consideration of being permitted to enter the premises and engaging any of the services offered by Theta Spring Hypnosis d/b/a Modrn Sanctuary (“Company”) (the “Activities”), I, the Client, agree to all the terms and conditions set forth in this agreement (the “Agreement”).

I acknowledge the following:

The information contained both herein and on Company’s website is designed to disseminate general information.  It is not intended to give medical or pharmacological advice and as such should not be relied upon as a substitute for professional medical advice.  Any such statements on the website or otherwise communicated by Company have not been evaluated by the U.S. Food and Drug Administration (“FDA”);
While there are many clinical and scientific studies conducted on Halotherapy (“Salt Therapy”) throughout the world, the FDA has not evaluated the statements made by these studies addressing the benefits and risks of Salt Therapy. 
Salt Therapy is not intended to diagnose, treat, cure or prevent any disease, ailment, pain, injury and/or other physical or medical condition and is not intended to substitute for medical care or treatment. Company recommends that all medical conditions should be diagnosed and treated by a qualified physician or other qualified healthcare practitioner.   If I have any questions about Salt Therapy, I will check with my doctor before proceeding.  Company assumes no responsibility for customers choosing to treat themselves;
I have been advised of the following possible side effects: dry or itchy throat, nasal drip, and increased coughing at the beginning.  All of these effects are a result of the respiratory system clearing itself out of pollutants.  The toxins, which have accumulated and lodged deep in the body over time, is loosened by the salt and expelled.  Generally, the side effects should cease with the removal of the pollutants.  Skin irritation and dermal sensitivity may occur. In such a case, decrease the frequency of sessions.

I make the following representations:

I am not presently nor have I in the past suffered from any medical condition including, but not limited to, acute stage of respiratory disease; cardiac insufficiency; heart disorders; chronic obstructive lung diseases with 3rd stage of chronic lung insufficiency; unexplained bleeding; expiration of blood; hypertension in II B stage; acute kidney disease; internal diseases in acute an acute stage; tuberculosis; cancer, all of which are contraindications to Salt Therapy;
I am not pregnant;
I do not have a fever, an infection or contagious condition;
I am not under the influence of alcohol, drugs or any other controlled substances; and
My participation in the Activities is purely voluntarily and no promises, warranties or representations were made to me by the Company to induce me to participate.

I UNDERSTAND THAT COMPANY DISCLAIMS ANY AND ALL WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, AS IT PERTAINS TO THE SALTH THERAPY INCLUDING, WITHOUT LIMITATION, ANY WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

I UNDERSTAND AND AGREE THAT IT IS MY VOLUNTARY DECISION TO PARTICIPATE IN SALT THERAPY. I, FULLY AND COMPLETELY, RELEASE AND DISCHARGE COMPANY, ITS AGENTS, OWNERS AND EMPLOYEES FROM ANY AND ALL LIABILITY OF ANY KIND RESULTING FROM MY USE OF THE ACTIVITIES OR RECEIVING SALT THERAPY.

All matters arising out of or relating to this Agreement shall be governed by and construed in accordance with the internal laws of the State of New York without giving effect to any choice or conflict of law provision.

BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTOOD ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE THE COMPANY.  I FURTHER WARRANT AND REPRESENT THAT I AM OF THE LEGAL AGE TO ENTER INTO THIS AGREEMENT.

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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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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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