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CUSTOMER WAIVER

WAIVER AND RELEASE AGREEMENT

*PLEASE READ CAREFULLY BEFORE SIGNING*

Physical Capability Requirements
Participation in a Whole Body Cryotherapy (WBC) session involves exposure to extreme cold temperature for a short period of time (not to exceed three and one-half (3:30) minutes per session). During the WBC session, the chamber technician will be present during the entire duration of your session. Additionally, you are free to walk out of the chamber at any time. The cold therapy session is followed by a five (5) to ten (10) minute period of light to moderate exercise.

LIABILITY AND MEDICAL RELEASE AND INDEMNIFICATION AGREEMENT
In consideration of being permitted by Catskill Cryo to participate in their services, I hereby waive any and all claims and damages for personal injury or death which may occur as a result of my participation. I understand and agree that:

1. This release is intended to discharge in advance, Catskill Cryo its officers, officials, employees, agents and volunteers from and against all liability arising out of or connected in any way with my participation in these activities;
2. Participation may involve risk of serious injury, illness, disability or death and may result not only as a result of my actions, negligence or inaction, but also from the action, negligence or inaction of others, including their owners, officers officials employees, or volunteers and may result from the conditions of the facilities, equipment, or areas where such activities are being conducted;
3. Knowing the risks involved and the contraindications related, I nevertheless chose voluntarily to request permission to participate;
4. I will indemnify and hold harmless Catskill Cryo, its owners, officers, officials, employees and volunteers from any loss, liability, damage, cost or expense, including litigation of any form, arising out of or connected in any manner with my participation in such activities;
5. I am in good health and have no physical condition expressed in the ‘Contraindications’ or otherwise which would preclude me from safely participating in such activities;
6. I understand and agree that this release is intended to be as broad and inclusive as permitted under the law of the State in which it is executed and that if any portion of this Hold Harmless, Release and Indemnification Agreement should be determined to be invalid, it is my intent that the remaining provisions shall continue in full force and effect.

I HAVE CAREFULLY READ THIS RELEASE INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A POTENTIAL CONFLICT BETWEEN MYSELF, AND MY HEIRS AND CATSKILL CRYO I VOLUNTARILY AGREE TO EACH OF THE TERMS AND PROVISIONS HEREIN AND SIGN THIS OF MY OWN FREE WILL.

I understand that it is mandatory to wear a headband, mask, mittens, tube socks, and enclosed footwear during my Whole Body Cryotherapy (WBC) session as a safety precaution. I also understand that I should not remove Personal Protective Equipment (PPE) at anytime during my Whole Body Cryotherapy (WBC) session.


I understand that wet or damp clothing cannot be worn at anytime during a Whole Body Cryotherapy (WBC) session. If you need dry clothing, loaner apparel is available upon request at the reception desk for free. Please ask the receptionist for more information.


I have completely read this waiver


Please do not use any photograph taken of me at your facility on your website, in any social media, or any promotional material.


Date: April 1, 2025

Please select who will be participating...
AdultMinor
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First Customer's Name

First Name*

Last Name*

Phone*
First Customer's Date of Birth*
First Customer's Information

Gender: *

EMERGENCY CONTACT


Contact Name: *

Contact Phone: *

Relationship: *

Health Questions

Absolute Contraindications

Have you ever had a heart attack within the previous 6 months?*
Do you have a pacemaker?*
Have you had a heart bypass or valvular disease within the previous 6 months?*
Do you have congestive heart failure?*
Do you have chronic obstructive pulmonary disease (COPD)?*
Do you have an intrathecal pain pump or any electro stimulation implant device? (i.e spinal stimulator implant)*
Do you have any chronic or acute kidney conditions?*
Are you pregnant?*

Relative Contraindications

Do you have a history of seizure disorders?*
Do you have cold allergies with known skin reactions to cold?*
Do you have any blood disorders (such as hemophilia or blood clots)?*
Do you have any major circulatory dysfunction (such as deep vein thrombosis)?*
Do you have Heart Arrhythmia or Atrial Fibrillation?*

Other Risk Factors

Do you have any open wounds, sores, or healing disorders?*
Are you under the influence of drugs or alcohol?*
First Customer's Signature*
Customer'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*
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.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Information

Gender: *

EMERGENCY CONTACT


Contact Name: *

Contact Phone: *

Relationship: *

Health Questions

Absolute Contraindications

Have you ever had a heart attack within the previous 6 months?*
Do you have a pacemaker?*
Have you had a heart bypass or valvular disease within the previous 6 months?*
Do you have congestive heart failure?*
Do you have chronic obstructive pulmonary disease (COPD)?*
Do you have an intrathecal pain pump or any electro stimulation implant device? (i.e spinal stimulator implant)*
Do you have any chronic or acute kidney conditions?*
Are you pregnant?*

Relative Contraindications

Do you have a history of seizure disorders?*
Do you have cold allergies with known skin reactions to cold?*
Do you have any blood disorders (such as hemophilia or blood clots)?*
Do you have any major circulatory dysfunction (such as deep vein thrombosis)?*
Do you have Heart Arrhythmia or Atrial Fibrillation?*

Other Risk Factors

Do you have any open wounds, sores, or healing disorders?*
Are you under the influence of drugs or alcohol?*
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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