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Pure Vibes Wellness Center Waiver and Release of Liability

Pure Vibes Wellness Center Waiver and Release of Liability

 

Thank you for visiting Pure Vibes Wellness Center.

We encourage you to relax and enjoy your time throughout the facilities. 

Kindly review and adhere to the Pure Vibes Wellness Center policies and terms below.

We are a CELL PHONE AND IPAD FREE ZONE in the Reception Area (silent usage is acceptable).
The Reception Area is a QUIET ZONE to allow our guests to have an uninterrupted experience of the wellness modalities offered in our facility.

I acknowledge all of these policies as I enter the Pure Vibes Wellness Center. 

I understand that I am entering quiet and cell phone free zones.

 

 

WELLNESS CENTER AMENITIES POLICIES
WAIVER AND RELEASE

 

COVID-19

You understand that COVID-19 is a contagious disease that can lead to severe illness and death. According to the CDC, senior citizens and persons with underlying medical conditions are especially vulnerable. You understand that by accessing any facilities or participating in any services at Pure Vibes Wellness Center, you voluntarily assume and agree to hold Pure Vibes Wellness Center, LLC harmless in regard to all risks related to exposure to COVID-19 (including being exposed to, contracting or spreading COVID-19), and that Pure Vibes Wellness Center, LLC waives all liability, in any form, for such risks, including any risks that arise from conduct by Pure Vibes Wellness Center, LLC or its agents, including negligence of such entities or persons.

 

READ BEFORE SIGNING

In consideration of my participation in Pure Vibes Wellness Center Amenities, which includes any and all fitness and wellness services and amenities offered or otherwise accessible at the Pure Vibes Wellness Center (the “Facility”) now or at any time in the future, whether provided by the Pure Vibes Wellness Center or a third-party service provider, including without limitation, massage, yoga, VibraSonic Pro X usage, VEMI usage, oxygen concentrator usage, fitness center, fitness equipment, and Reception Area Amenities and Services (collectively, the “Wellness Center Amenities”), I hereby release, discharge and covenant not to sue Pure Vibes Wellness Center, LLC and any third-parties providing such Wellness Center Amenities, nor their respective directors, officers, employees, affiliates, parents, subsidiaries, agents, representatives, insurers, clients, successors, assigns, nor any property owners, (“Released Parties”) and further release from liability the Released Parties from any and all claims, causes of action, losses, damages, or liability, INCLUDING WITHOUT LIMITATION NEGLIGENCE, RECKLESSNESS, BREACH OF WARRANTY, AND/OR OTHER CONDUCT AND LOSSES DUE TO THE NEGLIGENCE, RECKLESSNESS, BREACH OF WARRANTY AND/OR OTHER CONDUCT OF RELEASED PARTIES WHEN OPERATING, PERFORMING, OR INSTRUCTING ANY WELLNESS CENTER AMENITIES OR MAINTAINING THE FACILITY, resulting in personal injury, accidents, illnesses, death, or property loss, including theft, arising from participation in, use of, or presence in the Facility. I acknowledge that Released Parties are not able to diagnose illness or prescribe medical treatments or pharmaceuticals, and understand that Wellness Center Amenities are not medical and should not be considered a substitute for diagnosis or treatment by a licensed medical professional. I further understand that guests of the Facility should consult a physician regarding participation in the Wellness Center Amenities and that it is solely my responsibility to update Released Parties with all known physical conditions, medical conditions, medications, and any changes in health, and Released Parties shall not be liable for my failure to do so.   THIS WAIVER AND RELEASE IS EFFECTIVE AS OF THE DATE HEREOF AND SHALL REMAIN IN EFFECT UNLESS AND UNTIL THE FACILITY RECEIVES AN EXPRESS WRITTEN REVOCATION.  In the event this Waiver and Release is revoked, I agree that I will not be permitted to access any Wellness Center Amenities until a new waiver and release acceptable to the Released Parties is executed.

 

RISKS I understand participation in the Wellness Center Amenities carries certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. My participation in these Wellness Center Amenities is voluntary.  I assume all risk involved such participation, minor or major, including without limitation: bruising, product reaction, scratches, skin irritation, broken bones, allergic reactions, bleeding, eye injury, loss of sight, infection, permanent scarring, dermatological skin reactions, permanent skin discoloration, heart attacks, allergic reactions, concussions, personal injury, and catastrophic injuries such as paralysis or death.

 

CONDITIONS AND CONTRAINDICATIONS I understand that use of the VibraSonic Pro X is not appropriate for anyone who has is pregnant, has undergone a hip replacement surgery in the last 12 months, or has undergone a knee replacement surgery in the last 9 months, has had an IUD implanted in the last 8 weeks, or has undergone any surgery in the last 8 weeks.

 

I understand that the VibraSonic should only be used on the Low Setting for anyone who has deep vein thrombosis, epilepsy, partially detached retina, or spondylolisthesis, and that use of the VibraSonic Pro X with any of these conditions is at my own risk, and that I should consult with a physician before use of the vibration technologies provided in the Facility.

 

 

 

PERSONAL PROPERTY I acknowledge it is the policy that guests not bring or leave valuables in the Facility. Released Parties are not liable for any theft, destruction, or loss of personal property, including jewelry or other personal items. In no event shall the Released Parties be liable for property exceeding $1,000 and will only be liable for that amount if the item was registered with the Facility and the loss was caused solely by the fault of the Released Parties.

 

By signing this document, I acknowledge I have read and agree to the terms stated herein.

 

February 6, 2023

Please select who will be participating in Pure Vibes Wellness Center Amenities...
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First Participant's Name

First Name*

Middle Name

Last Name*

Phone*
First Participant's Date of Birth*
First Participant's Signature*
Second Participant's Name

First Name*

Middle Name

Last Name*
Second Participant's Date of Birth*
Third Participant's Name

First Name*

Middle Name

Last Name*
Third Participant's Date of Birth*
Fourth Participant's Name

First Name*

Middle Name

Last Name*
Fourth Participant's Date of Birth*
Fifth Participant's Name

First Name*

Middle Name

Last Name*
Fifth Participant's Date of Birth*
Sixth Participant's Name

First Name*

Middle Name

Last Name*
Sixth Participant's Date of Birth*
Seventh Participant's Name

First Name*

Middle Name

Last Name*
Seventh Participant's Date of Birth*
Eighth Participant's Name

First Name*

Middle Name

Last Name*
Eighth Participant's Date of Birth*
Ninth Participant's Name

First Name*

Middle Name

Last Name*
Ninth Participant's Date of Birth*
Tenth Participant's Name

First Name*

Middle Name

Last Name*
Tenth Participant's Date of Birth*
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*
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*

Middle Name

Last Name*

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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