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We are thrilled that you are interested in participating in our infrared sauna and cold plunge services. This participation involves exposure to extreme temperatures (i.e. hot and cold). All NEW clients must have a Unify representative in attendance to assist you during your first contrast experience. At any time you feel uncomfortable with participation, are unwell, or for whatever personal reason, you feel the need to stop, you may cease participation immediately. 



LIABILITY AND MEDICAL RELEASE/INDEMNIFICATION AGREEMENT

After clearance by Unify to participate in their services, I hereby waive any and all claims for 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 UNIFY, its owner, employees, and volunteers against all liability arising out of or connected in any way with my participation in these activities.

2. Participation may involve the risk of serious injury, illness, or disability 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 Unify owner, employees, volunteers, and may result from the conditions of the facilities, equipment, or areas where such activities are being conducted.  

3. In understanding and knowing the risks involved, I voluntarily have chosen to participate in the activities and services provided by Unify. 

4. I will indemnify and hold harmless Unify, its owner, and employees, of any cost or expense, including litigation of any form, arising out of or connected in any way to my participation in activities and services provided by Unify. 

5. I am in good health and have non of the aforementioned conditions listed above which would preclude me from participating in these activities. 

6. I understand and agree that this release is intended to be broad and inclusive as permitted by the law of the State of Arizona or the jurisdiction in which it was executed. If any portion of this agreement is determined to be invalid in that jurisdiction, it is my intent that the remaining provisions shall continue in full force and effect. 

I HAVE FULLY READ AND ANSWERED TO THE BEST OF MY ABILITY THE QUESTIONS STATED ABOVE. I AM AWARE THIS IS A RELEASE OF LIABILITY AND A POTENTIAL CONFLICT BETWEEN MYSELF, MY HEIRS AND UNIFY. I VOLUNTARILY AGREE TO EACH OF THE TERMS AND P


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*
Parent or Guardian's Email Address

Email*

Confirm Email*
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Have you had any type of cardiac event in the past 2 years?
Click to customize question*
No
Yes
Do you have undergone any cardiac related procedure or surgery?
Click to customize question*
No
Yes
Do you have a pacemaker?
Click to customize question*
No
Yes
Do you have congestive heart failure?
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No
Yes
Do you have an intrathecal pain pump or electro stimulation implant?
Click to customize question*
No
Yes
FEMALES: Are you pregnant? Extreme temperatures are a contraindication for those pregnant
Click to customize question*
No
Yes
Females: I understand that I may not participate in the cold plunge portion while on menstrual cycle. A failure to comply may lead in a $150 cleaning fee.
Click to customize question*
No
Yes
Do you have a history of seizures or fainting?
Click to customize question*
No
Yes
Do you currently have any open wounds or sores? If yes- please refrain from cold plunge participation. A $150 cleaning fee will be applied if failure to do so.
Click to customize question*
No
Yes
Do you have any known allergies or skin reactions to extreme hot or cold?
Click to customize question*
No
Yes
Do you have any diagnosed blood disorders? (i.e. blood clotting/hemophilia)
Click to customize question*
No
Yes
Do you have any major circulatory dysfunction? (i.e. DVT)
Click to customize question*
No
Yes
Are you currently under the influence of drugs (recreational or prescription)?
Click to customize question*
No
Yes
Have you consumed alcohol in the last 6-8 hours?
Click to customize question*
No
Yes
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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