The undersigned (“Participant”) desires to participate in an event (the “Event”) which may be sponsored or controlled by AllCore Holdings, LLC and/or its affiliates, assignees, or licensees (individually and collectively, the “Company”), in which the Event involves the use of the Company’s AllCore360° and/or Full-Spectrum Infrared Sauna device (“Device”). The Event may occur at a facility owned or leased by the Company (the “Facility”). As consideration and as a condition for the Company’s (i) grant of access to the Facility to participate in the Event and to use the Device, Participant, by his or her execution of this Participant Release & Waiver (this “Release”), agrees as follows: - Participant acknowledges and agrees that the Event involves the use of the Device and involves physical activity. Participant understands and acknowledges that physical exercise can be strenuous and may subject Participant to serious injury. Participant acknowledges that he or she has not been advised by a medical professional to avoid physical activity or exercise. To the extent that Participant has not discussed his or her participation in the Event or use of the Device with a medical professional, the Company recommends Participant to obtain a physical examination from Participant’s physician before commencing with any activity incident or related to the Event and the Device.
- Participant understands and acknowledges that his or her participation in the Event and use of the Device is completely voluntary and at his or her own risk, and that none of Company or its respective affiliates, officers, shareholders, directors, agents, employees, contractors, personal representatives and assigns, and anyone acting on their behalf (individually, a “Released Party” and collectively, the “Released Parties”) is requiring Participant to participate in the Event, to use the Device, or to undertake any related activity. Participant also understands and acknowledges that she/he engages in the Event and any related activity at her/his own risk and that Participant’s participation in the Event and any related activity may expose her/him to certain known, unknown and unanticipated hazards, risks and dangers associated, including, but not limited to, personal injury, illness and loss or damage to personal property, and Participant specifically assumes any and all such risks. The Released Parties have not made, and do not make any warranties or representations with respect to the Facility or the Device or the condition thereof. Participant agrees to follow all rules established by Company while participating in the Event, as such rules exist and may be amended from time to time.
- Participant understands and acknowledges that Company may, or may not, have the medical staff or resources available to store or administer prescription or non-prescription medications for Participant or to otherwise treat any medical condition (known or unknown) of Participant during Participant’s participation in an Event or use of the Device. Participant hereby authorizes Company to obtain or administer medical care or treatment deemed necessary if Participant suffers any injury, illness or other medical condition while she/he is participating in the Event and any related activity at the Facility.
- Participant hereby waives, releases, agrees to hold harmless, and forever discharges Company and each and every Released Party from any and all liability, claim, demand or action for personal injury (including death), illness, accident, property damage or any other loss, damage, injury, judgment, cost or expense resulting directly or indirectly from (i) Participant’s participation in the Event or use of the Device, whether at the Facility or at any other location; (ii) any act or failure to act, including, but not limited to, negligence, by or on the part of the Released Parties, which may in any way arise out of Participants participation in the Event or use of the Device; (iii) Participant’s presence in the Facility for the purpose of the Event or to use the Device, or traveling through the Facility to or from any activity related or incident to the Event; (iv) any rendering of medical care to Participant by a Released Party, by any other participant, or by any agent of a Released Party or another participant; or (v) any and all other activity incident or related to the Facility, the Event, or the Device, or any of the foregoing matters. Nothing in this Release is intended to exculpate Company or any Released Party from any willful or wanton conduct.
- Participant understands that Participant may be photographed or videotaped while participating in the Event or using the Device, and Participant agree that the Company may use any HIPPA-compliant data generated from the session expressly for research and design, as well as system performance reporting, as well as any photo, video, or film likeness to be used for any legitimate purpose by the Company or its assigns, including, without limitation, online or print advertising, social media postings, or the like.
- In addition, the Device may or may not incorporate the use of red-light therapy and full spectrum infrared therapy to enhance therapeutic application and may promote additional wellness benefits. Contraindications for the use of red-light therapy, include, but are not limited to the following: history of photosensitivity or epileptic seizures. Due to the nature of the light therapy, this treatment may result in triggering photosensitivity reactions and may increase the risk of triggering epileptic seizures. History of heat insensitivity. While the treatment only gives off a small amount of heat, Participant understand that if Participant has issues feeling and registering an increase in skin temperature this may be contraindicated. Currently taking medications that are known to increase skin sensitivity to light (if Participant is, Participant has express approval from a physician) as certain medications can increase the risk of photosensitivity reactions. Additional contraindications include current pregnancy and/or may become pregnant. Contraindications for the use of full spectrum infrared therapy, include, but are not limited to the following: Pregnant women should consult a physician before using the sauna because fetal damage can occur with a certain elevated body temperature. Individuals who are using prescription drugs should seek the advice of their personal physician or a pharmacist for possible changes in the drugs effect when the body is exposed to infrared waves or elevated body temperature. Diuretics, barbiturates and beta-blockers may impair the body’s natural heat loss mechanisms. Some over the counter drugs such as antihistamines may also cause the body to be more prone to heat stroke. Current medical conditions including Parkinson’s, Multiple Sclerosis, Central Nervous System Tumors and Diabetes with Neuropathy are conditions that are associated with impaired sweating. Individuals with cardiovascular conditions or problems (hypertension / hypotension), congestive heart failure, impaired coronary circulation or those who are taking medications, which might affect blood pressure, should exercise caution when exposed to prolonged heat. Heat stress increases cardiac output, blood flow, in an effort to transfer internal body heat to the outside environment via the skin (perspiration) and respiratory system. This takes place primarily due to major changes in the heart rate, which has the potential to increase by thirty (30) beats per minute for each degree increase in core body temperature. If Participant is currently diagnosed with one of the following conditions above, Participant has express approval from a physician that the use of full spectrum infrared therapy will not worsen the current condition and Participant hereby releases all liability should the diagnosed condition be exacerbated from use of the Device. Metal pins, rods, artificial joints or any other surgical implants generally reflect infrared waves and thus are not heated by this system, nevertheless Participant should consult Participant’s surgeon prior to using an infrared sauna. Certainly, the usage of an infrared sauna must be discontinued if Participant experiences pain near any such implants. Silicone does absorb infrared energy. Implanted silicone or silicone prostheses for nose or ear replacement may be warmed by the far infrared waves. Since silicone melts at over 200°C (392°F), it should not be adversely affected by the usage of an infrared sauna. It is still advised that Participant checks with Participant’s surgeon and possibly a representative from the implant manufacturer to be certain. If Participant has a recent (acute) joint injury, it should not be heated for the first 48 hours after an injury or until the hot and swollen symptoms subside. If Participant has a joint or joints that are chronically hot and swollen, these joints may respond poorly to vigorous heating of any kind. Vigorous heating is strictly contra-indicated in cases of enclosed infections be they dental, in joints or in any other tissues. The core body temperature of children rises much faster than adults. This occurs due to a higher metabolic rate per body mass, limited circulatory adaptation to increased cardiac demands and the inability to regulate body temperature by sweating. Consult with the child’s Pediatrician before using the sauna. An adult must accompany anyone under 18.
The Department of Health and Human Services has established a "Privacy Rule" to help ensure that personal health care information is protected for privacy. The Privacy Rule was also created in order to provide a standard for certain health care providers to obtain their patients' consent for uses and disclosures of health information about the patient to carry out treatment, payment, or health care operations. As our patient we want you to know that we respect the privacy of your personal medical records and will do all we can to secure and protect that privacy. We strive to always take reasonable precautions to protect your privacy. When it is appropriate and necessary, we provide the minimum necessary information to only those we feel are in need of your health care information and information about treatment, payment or health care operations, in order to provide health care that is in your best interest. We also want you to know that we support your full access to your personal medical records. We may have indirect treatment relationships with you (such as laboratories that only interact with physicians and not patients), and may have to disclose personal health information for purposes of treatment, payment, or health care operations. These entities are most often not required to obtain patient consent. Participant may refuse to consent to the use or disclosure of your personal health information, but this must be in writing. Under this law, we have the right to refuse to treat you should you choose to refuse to disclose your Personal Health Information (PHI). If you choose to give consent in this document, at some future time you may request to refuse all or part of your PHI. You may not revoke actions that have already been taken which relied on this or a previously signed consent. If you have any objections to this form, please ask to speak with our HIPAA Compliance Officer. You have the right to review our privacy notice, to request restrictions and revoke consent in writing after you have reviewed our privacy notice. The misuse of Personal Health Information (PHI) has been identified as a national problem causing patients inconvenience, aggravation, and money. We want you to know that all of our employees, managers and doctors continually undergo training so that they may understand and comply with government rules and regulations regarding the Health Insurance Portability and Accountability Act (HIPAA) with particular emphasis on the “Privacy Rule.” We strive to achieve the very highest standards of ethics and integrity in performing services for our patients. It is our policy to properly determine appropriate use of PHI in accordance with the governmental rules, laws and regulations. We want to ensure that our practice never contributes in any way to the growing problem of improper disclosure of PHI. As part of this plan, we have implemented a Compliance Program that we believe will help us prevent any inappropriate use of PHI. Our policy is to listen to our employees and our patients without any thought of penalization if they feel that an event in any way compromises our policy of integrity. More so, we welcome your input regarding any service problem so that we may remedy the situation promptly. Participant, acknowledges that he or she has carefully read this Participant Release and Waiver, fully understands that it is a release of liability, agrees that the pricing of the Event and the use of Device has been established in direct reliance upon the agreements of Participant reflected in this document, it is intended to be construed as broadly as possible to provide a release and waiver to the maximum extent under applicable law, and accepts and specifically agrees to its terms evidenced by Participant’s execution of this Release as of the date or dates below indicated. This Participant Release and Waiver is subject to and shall be governed by the laws of the State of Georgia |
