Assumption of Risk

ASSUMPTION OF RISK

PLEASE TAKE A MOMENT TO CAREFULLY READ THE FOLLOWING INFORMATION AND SIGN WHERE INDICATED.

I understand that the Lakeside Immersion is provided for the basic purpose of relaxation and relief of muscular tension. If I experience any pain or discomfort during this session, I will immediately inform the event coordinator. I further understand that The Lakeside Immersion should not be construed as a substitute for medical examination, diagnosis, or treatment and that I should see a physician, chiropractor or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that the practitioners/ event coordinators are not qualified to diagnose, prescribe, or treat any physical or mental illness, and that nothing said in the course of the session given should be construed as such. Lakeside Immersion is a form of Contrast Therapy. Because Contract Therapy should not be performed under certain medical conditions, I affirm that I have stated all my known medical conditions, and answered all questions honestly. I agree to keep the practitioner updated as to any changes in my medical profile and understand that there shall be no liability on the practitioner’s part should I forget to do so. It is also understood that any illicit or sexually suggestive remarks or advances made by me will result in immediate termination of the session, and I will be liable for payment of the scheduled appointment.

Spa Services, including but not limited to, Steam, sauna, massage, facials, body treatments, manicures, pedicures and contrast therapy, hydrotherapy may be dangerous under certain conditions. In consideration of the fee charged and paid by me, and to the fullest extent permitted by law I hereby release Smiley Brothers, Inc. dba Mohonk Mountain House and its employees and agree to hold it and them harmless for any and all liability, claims, damages, actions and causes of action whatsoever, for loss, damage or injury to person or property, irrespective of how arising and however caused. This includes but not limited to all kinds and degrees or extent or negligence (except willful or wanton negligence or misconduct) which Smiley Brothers, Inc. d.b.a Mohonk Mountain House and its employees may commit or be charged with in connections, directly or indirectly with the use of the spa equipment and facilities and related activities.

If you have heart disease, hypertension (high blood pressure), cancer; if you are pregnant; if you have been advised by your physician to limit your physical activities in any way; or, if you have any medical conditions, allergy, injury or illness which may be affected by the use of the spa facility or services, you must notify a receptionist, attendant or therapist prior to engaging in any spa service or event.

By signing this document, you are certifying that such disclosure has been made. By signing this document you are also agreeing that if there is a claim or dispute that arises out of the use of the facilities that results in any legal action being brought as a result of the use at any of the facilities, all issues will be settled by the Courts of the State of New York, Ulster County, which we agree shall have exclusive jurisdiction over every party in connection with any such dispute, lawsuit, or claim.

For your comfort during your visit a robe and pair of slippers that are the property of Mohonk Mountain House will be provided for your use. They are to be returned at the end of your visit to the designated laundry bins.

I Agree

In order to maintain the tranquil atmosphere of our spa for you and for our other guests, cell phones and electronic equipment are to be turned off and not used. Cameras are also not permitted in the spa.

I Agree

Today's date: November 23, 2024

Please select who will be participating...

Adult Minor(s)
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First Participant's Name

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First Participant's Age Acknowledgment*

First Participant's Date of Birth*

I certify that I am 18 years of age or older

First Participant's Signature*

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Second Participant's Name

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Second Participant's Date of Birth*

Third Participant's Name

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Third Participant's Date of Birth*

Fourth Participant's Name

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Fourth Participant's Date of Birth*

Fifth Participant's Name

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Fifth Participant's Date of Birth*

Sixth Participant's Name

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Sixth Participant's Date of Birth*

Seventh Participant's Name

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Seventh Participant's Date of Birth*

Eighth Participant's Name

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Eighth Participant's Date of Birth*

Ninth Participant's Name

First Name*

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Ninth Participant's Date of Birth*

Tenth Participant's Name

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Tenth Participant's Date of Birth*

Parent or Guardian's Email Address

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Consent to Treatment of Minor: By my signature below, I hereby authorize SBI Practitioner to administer massage, bodywork, or somatic therapy techniques to my child or dependent as they deem necessary.

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

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Phone*

Parent or Guardian's Age Acknowledgment*

Parent or Guardian's Date of Birth*

I certify that I am 18 years of age or older

Parent or Guardian's Signature*

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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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