Loading...

2ND WIND ENERGY

dba 2ND WIND PULSE

INFORMED CONSENT FORM


By using and/or purchasing the Pulsed Electromagnetic Field (PEMF) Cellular Exercise system (the “System”) from 2ND WIND ENERGY LLC DBA 2ND WIND PULSE, the undersigned confirms that they meet the standards set forth below and agrees to the terms set forth below and the Standard Terms and Conditions laid out in this document. This acceptance includes an obligation to arbitrate all claims and disputes as provided herein, including any claims for injury, and a submission to jurisdiction as set forth herein. This is a binding legal obligation

The system is designed to promote and support overall wellness and the body’s natural abilities. All uses of the System will be only to serve those purposes


Do NOT use if:

● User has an implanted electronic device including but not limited to a pacemaker, defibrillator, cochlear hearing device, spinal stimulator, glucose monitor, or insulin pump

● User has an implanted magnetic device including those deemed “unsafe for MRI” and those manufactured from ferromagnetic materials

● User is pregnant

● User is actively bleeding or hemorrhaging outside of normal menstrual bleeding

● User has blood clots and has not been cleared by a physician

● User is the recipient of an organ transplant

● User has injuries or concerns of injuries that have not yet been evaluated by a licensed healthcare provider.

I Agree


If you are unsure whether PEMF is right for you, consult with your licensed healthcare provider(s).

During a PEMF Session, Users should:

● Suspend the session and consult a licensed healthcare provider if they begin to experience natural reactions that include but are not limited to nausea, headache, fatigue, muscle soreness, increased menstrual flow, or any uncomfortable sensations.


Before beginning a PEMF Session, Users should:

● Remove metal, electronic, and battery-operated devices, keys, wallets, cards with magnetic strips such as credit cards and hotel keys, jewelry, and hearing aids.

● Be aware that metal implants may be sensitive to electromagnetic stimulation and may need to be pulsed at lower strengths.

I Agree


PEMF Treatment

Waiver and Liability Release Form

I hereby state that I am at least 18 years of age and have read, understand, and agree to this Waiver and Liability Release Statement, that it is an informed release and that I intend to be legally bound by it.

I agree and understand that the following must be adhered to during treatment, and I agree to ensure I comply with the following for myself or the entity being treated:

  1. Not currently undergoing chemotherapy nor currently pregnant.
  2. Do not have a pacemaker or other implanted stimulator.
  3. No chains, cell phones, electronic watches, or credit cards (other jewelry is OK).
  4. No car keys with intelligent chips near the treatment area.

I agree to be fully responsible for any damages if I do not follow the above instructions. 

I Agree

I know that I am using a magnetic pulse generator and that it is not FDA approved to treat or cure any disease or condition. I understand that this is an experimental device.

By my signature below, I acknowledge that I have read the following, understand it and agree to the terms:

No one has made any representations or claims to me of any treatment or cure for any disease or condition; or any promise of any specific or general results of any kind regarding treatments on myself or on the animal I own or am in control of. I release from all general, medical and any other liability or claims of any kind, and I indemnify and hold harmless,          2nd Wind Energy LLC dba 2nd Wind Pulse     and its respective officers, directors, agents, servants, employees, divisions, subsidiaries, shareholders, partners, members, affiliated companies, successor and assigns, the magnetic pulse generator, the manufacturer, distributor, dealer and any of their employees or agents (the "Company") from any claim arising from or related to my use of the magnetic pulse generator. Should anyone acting on my behalf be required to incur attorney's fees and costs to enforce this agreement, I agree to indemnify and hold harmless the Company for all such fees and costs. I agree that this liability shall be interpreted and governed by the laws under which the Company is domiciled at the time of the treatment.

I Agree


AGREEMENT, ACKNOWLEDGMENT, AND ACCEPTANCE OF TERMS OF USE Standard Terms and Conditions for All Users

By signing this Agreement, Acknowledgment, and Acceptance of Terms of Use document, the person being bound (“I” or “me” or “my”) hereby requests one or more Pulsed Electromagnetic Field Cellular Exercise sessions with the “2ND WIND ENERGY LLC DBA 2ND WIND PULSE” PULSE system (the “System”).

I Agree to this Demonstration. I understand that the System produces electromagnetic field energy, which passes freely through human tissue. The FDA has not evaluated the System. It is not intended for the diagnosis, treatment, or cure of any medical condition. The System is not a medical device and neither 2ND WIND ENERGY dba 2ND WIND PULSE nor its affiliates and customers can make any claims that the System can affect medical conditions As a user of a 2ND WIND ENERGY dba 2ND WIND PULSE PULSE system, I agree to be cautious in any experimental area and will notify the demonstrator or operator of the System of any discomfort. As an owner or operator of a System, I agree to complete complimentary online training on the System before using it on myself or other humans, and when operating the system, to check for any signs of discomfort and adjust the System operation accordingly, including the option of stopping the session I will not take any actions that could endanger my health or safety or that of any other person. 

I Understand My Obligations. I understand that the System only operates as described in written material approved by 2ND WIND ENERGY dba 2ND WIND PULSE and will not rely on any oral statements from any demonstrator, who may have unverified information based on personal experience. Such statements are for discussion and educational purposes only. I agree to abide by all restrictions and obligations of 2ND WIND ENERGY dba 2ND WIND PULSE, including those set forth herein. I will fully comply with the restrictions and obligations contained herein, and all policies applicable to me, and will interpret my obligations hereunder broadly, in order to protect 2ND WIND ENERGY dba 2ND WIND PULSE. I agree to execute binding documents to this effect upon request. I acknowledge that the opportunity to experience the System is sufficient consideration for my agreement to these terms. 

General Release. I understand that there may be other unforeseeable risks associated with a pulsed electromagnetic field cellular exercise session and that the demonstrator, the manufacturer, the marketer, employees, agents, and affiliates cannot accept any liability for loss or damages incurred as the result of the System session. IN NO EVENT SHALL 2ND WIND ENERGY LLC DBA 2ND WIND PULSE BE LIABLE FOR ANY INJURY, LOSS OF PROFITS, REVENUE OR DATA, INDIRECT, INCIDENTAL, SPECIAL, OR CONSEQUENTIAL DAMAGES ARISING OUT OF OR IN CONNECTION WITH THE SYSTEM. ALL DAMAGES SHALL BE LIMITED TO THE PRICE PAID FOR THE SYSTEM. THE LIMITATIONS OF DAMAGES SET FORTH ABOVE ARE FUNDAMENTAL ELEMENTS OF THE BASIS OF THE BARGAIN BETWEEN THE PARTIES. I have read this form, and I voluntarily agree to the System session on my person mentioned above assuming all liability for any and all results or consequences. I hereby indemnify, release, and hold harmless, and agree to defend, 2ND WIND ENERGY dba 2ND WIND PULSE and its affiliated companies, and their employees, agents, or affiliates of any of them (the “Released Parties”) from any and all loss and liability or claims of loss or any statutory duties or duties of care arising from or in connection with my use of the system, at any time now or in the future, except to the extent arising from gross negligence or willful misconduct, but even then all claims shall be determined by arbitration as set forth below. Should medical treatment become necessary for any reason, including as a result of an emergency, I hereby release and forever discharge the Released Parties from any claim whatsoever that arises or may arise on account of any first aid, treatment, or medical service, including the lack or timing of same. 

Publicity Release. I understand that in demonstration situations, the use of the technology on myself may be observed by cameras. I agree to be photographed, videoed, or recorded by 2ND WIND ENERGY dba 2ND WIND PULSE or its employees, users, or agents, and agree that 2ND WIND ENERGY dba 2ND WIND PULSE can use such photographs, videos, or recordings and license such use to others who can use these rights (“Recordings”). This grant of rights to my likeness will be interpreted broadly to include all digital and similar forms of photographic capture. I hereby grant to 2ND WIND ENERGY dba 2ND WIND PULSE and its successors, assigns, and licensees a worldwide, royalty-free, perpetual, irrevocable, and transferable license and permission to use my name, likeness, biographical data, photographs, images, and/or voice as captured. This license includes, without limitation, the right to use, reproduce, make derivative works of, distribute, transmit, publicly display, and publicly perform the Recordings for publicity, advertising, research, educational, promotional, commercial, or any other purposes, and to sublicense all such rights, in any language, manner, and media now known or hereafter developed, alone or in combination with other works. I irrevocably assign to 2ND WIND ENERGY dba 2ND WIND PULSE in perpetuity all right, title, and interest in and to the Recordings, including all copyrights in the Recordings. I understand that the Recordings may be distributed commercially by 2ND WIND ENERGY dba 2ND WIND PULSE. I agree that the rights I grant hereby shall include any derivative rights or moral rights. I agree that this license shall be worldwide and perpetual. 

Confidentiality. I will keep the terms of this agreement confidential except to the extent I am authorized by 2ND WIND ENERGY dba 2ND WIND PULSE or their authorized representative to disclose it. 

Dispute Resolution. This Agreement shall be governed by the laws of the State of California, without regard to conflict of law provisions. The parties may mutually agree to attempt to resolve any dispute through good faith mediation. If a dispute arises related to this agreement or services provided by 2nd Wind Pulse, and it is not resolved through mediation or negotiation within five (5) business days of written notice, the matter shall be resolved exclusively by a single arbitrator under the Streamlined Arbitration Rules and Procedures of JAMS, conducted in Los Angeles County, California. The arbitration shall be administered by JAMS, and the arbitrator shall have authority to determine their own jurisdiction, including the scope and enforceability of this agreement.

Small Claims Court Exception: Notwithstanding the arbitration requirement above, either party may bring an individual action in Los Angeles County Small Claims Court if the claim is within the court’s jurisdiction and does not involve injunctive relief or class-wide claims.

Each party shall bear its own attorneys’ fees and costs associated with any arbitration or legal proceeding, unless otherwise required by law.

I agree to submit to the jurisdiction of the state and federal courts located in Los Angeles County, California for the limited purpose of enforcing any arbitration decision or award. Any arbitration award shall be final, binding, treated, and maintained as confidential information by all parties, unless disclosure is required by law. 

The undersigned agrees to the terms and conditions set forth in this document. I have carefully read this document and fully understand its contents. I AM AWARE THAT THIS IS A CONTRACT BETWEEN MYSELF AND 2ND WIND ENERGY LLC DBA 2ND WIND PULSE AND CONTAINS AN ASSUMPTION OF RISK AND A RELEASE OF LIABILITY FOR MYSELF AND MY PROPERTY, AND I SIGN IT OF MY OWN FREE WILL. By signing this release, I certify that I am eighteen (18) years of age or older or have delivered the consent of my parent(s) or guardian to 2ND WIND ENERGY dba 2ND WIND PULSE.

 

I Agree

First Participant's Name
First Name*
Last Name*
First Participant's Age Acknowledgment*
First Participant's Date of Birth*
Date of Birth
I certify that I am 21 years of age or older
First Participant's Signature*
Second Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Third Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fourth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Fifth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Sixth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Seventh Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Eighth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Ninth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Tenth Participant's Name
First Name*
Last Name*
Participant's Date of Birth*
Date of Birth
Parent or Guardian's Email Address
Email
Check to receive information, news, and discounts by e-mail.
Your signed waiver will be sent to the email address provided here and is available for download for three days via URL attachment.
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 Age Acknowledgment*
Parent or Guardian's Date of Birth*
Date of Birth
I certify that I am 21 years of age or older
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.


One or more problems exist. Please scroll up.




Powered by  Smartwaiver - TRY IT FREE!