RXR3 Recovery Lounge LLC went GREEN!
We have included all the RXR3 Recovery Lounge LLC forms/waivers/releases in one document. You will not be able to edit the waiver once it's completed.
IT'S ALL ABOUT YOU!
The RXR3 Recovery Lounge LLC Team sincerely wishes this to be the most beneficial experience possible for you! We believe that although we are the therapists, nothing can substitute for your feedback and perspective on what you are feeling or experiencing during your session. In an effort to help us serve you better, it is your responsibility to let us know the following:
- If at anytime you feel faint or dizzy
- If you feel uncomfortable or uneasy in any way
- If you want less pressure
- If you are too cold or too hot
- If you feel an area needs more attention or if an area is overworked
- If you want more stretching or if you want a stretch to go deeper
- If we do something that you love and you want us to repeat it
NOTE: None of these therapies should be used while under the influence of alcohol or drugs.
If anything makes you feel uncomfortable in any way while under RXR3 Recovery Lounge LLC 's care, please let us know!
If any items listed below apply to you, be certain to consult with your physician before using the NormaTec compression equipment:
- Deep Vein Thrombosis
- Atherosclerosis or other Ischemic Vascular diseases
- Congestive Cardiac Failure
- Existing Pulmonary Edema or Embolism
- Deformity of the Limbs
- Local Tissue or Skin Conditions which the garments would interfere with (gangrene, untreated or infected wounds, recent skin grafts, dermatitis)
- Known Presence of Malignancy in Legs
- Limb Infections, including Cellulitis, that have not received antibiotic coverage
- Presence of Lymphangiosarcoma
- Bone Fractures at or near the site of application
Do NOT use Whole Body Cryotherapy if you have any of the following conditions:
- Raynaud’s Syndrome
- High Blood Pressure
- Heart Attack
- Narrowing of Heart Valves
- Crescent-shaped Aorta and Mitral Valve
- Chest Pain (angina pectoris) and Arrhythmias
- Symptomatic Cardiovascular Disease
- Cardiac Pacemaker
- History of Blood Clots
- Cold Allergy
- Nerve Pain in Feet or Legs
- Open Sores
- Condition or Disease with Increased Sensitivity to Cold
- Peripheral Arterial Occlusive Disease
- Venous Thrombosis
- Cerebrovascular Accident (Stroke: must be cleared for exercise)
- Tumor Disease
- Symptomatic Lung Disorders
- Bleeding Disorders
- Severe Anemia
- Infection/Open Sores
- Activation of Viral Conditions (cold sores, etc.) due to immune system stimulation
- Kidney and Urinary Tract Diseases
You may have other conditions that make whole body cryotherapy inappropriate. Consult with your doctor or medical adviser if you have any questions as to whether whole body cryotherapy is right for you.
1. Follow all instructions given to you by the attendant. Do not use whole body cryotherapy without an attendant present.
2. Participation in a whole-body cryotherapy session involves exposure to extreme cold temperature for a short period of time (not to exceed three (3) minutes per session). Your clothing and skin must be dry. You must avoid inhaling the nitrogen gas that is emitted into the equipment. By signing this Agreement, you confirm that you are in good health and do not have any of the contraindications identified above or other physical condition that would preclude you from safely using whole body cryotherapy.
3. If you experience any pain or mental or physical discomfort at any time during the process, you may terminate the session immediately. The chamber will not be locked, and you are free to walk out of the chamber at any time. You agree that you have familiarized yourself with this exit process and are prepared to do so if or when you feel it is necessary.
4. No representations or claims are made as to the therapeutic nature or other benefits of whole body cryotherapy. Whole body cryotherapy is not intended to diagnose, treat, cure or prevent diseases, illnesses, imbalances or disorders. No results from whole body cryotherapy are assured. Every customer is different and responds differently to the therapy.
CVAC HIIT Cell Trainer
Do NOT use CVAC HIIT Cell Trainer if you have any of the following conditions:
- Cold, flu, sinus allergies or infection, toothache or infection, or any condition that would prevent you from equalizing the pressure in your ears
- You are not cleared to exercise by a doctor (CVAC is a form of exercise)
- You are not cleared to fly on an airplane by a doctor
Floatation Therapy provides a deep state of relaxation that stimulates blood flow throughout all the tissues, releases endorphins, and allows the brain to discharge alpha waves associated with relaxation and meditation. To ensure a comfortable, clean and safe, Float experience, I agree to the following:
- I do not have any communicable or infectious disease, illness, or skin disorder.
- I do not have a condition, nor am I medicated in any manner that may be adversely affected by profound relaxation and/or immersion in concentrated magnesium sulfate (Epsom salt) water solution.
- I am not under the influence of any medication, drug or alcohol.
- I do not have an uncontrolled high (>= 180/120) or low (<=90/50) blood pressure.
- I am not diabetic with an insulin dependency.
- I do not have kidney disease.
- I do not suffer from seizures or epilepsy.
- I am not currently menstruating.
- I have secured written permission from my physician to use the Floatation Room if I am pregnant.
- Occasionally people may feel nauseous during their first float. I agree to leave the Float Room if I feel nauseous.
- I do not have a recent hair dye or tattoo.
- I do not have difficulty with bladder/bowel control. I understand that if I contaminate the float tank solution, I will be required to pay the cost of cleanup and refilling the pod with salt.
I understand that the Floatation Room uses:
- Pharmaceutical grade Epsom salts
- Ultraviolet sterilization system
- Baking Soda
- Natural enzymes and non-toxic biodegradable cleaning products
- Food Grade Hydrogen Peroxide
Agreements: I am choosing to use floatation therapy of my own free will and will not hold the owner/operator or RXR3 Recovery Lounge LLC liable for any unpleasant emotions or nausea during the float. I have read, understand and agree to all the terms & policies listed above.
Drink plenty of water before, during and after your session. Adding electrolyte mix is recommended if you are an athlete in training, or have medical conditions that require additional electrolytes.
If any items listed below apply to you, be certain to consult with your physician before using the Infrared sauna:
- Insensitivity to heat
- Cardiovascular conditions/Pacemakers/Defibrillators
- Implants/Artificial Joints
- Recent Joint Injury
If at any time during your session you feel dizzy or light headed, get out of the sauna and inform us immediately.
Do NOT participate in KAATSU Training if you have any of the following conditions:
- Myocardial infarction
- Ventricular tachycardia or severe arrhythmia
- Cardiac insufficiency (NYHA class IV)
- Aortic stenosis
- Pulmonary embolism or lung infarction
- Myocarditis or pericarditis
- Vena cava dissociation
- Under age 14
- Undergoing any type of heart rehabilitation
LightStim LED Bed
Although LED has no contraindications, if you are suffering from cancer, a terminal illness, or you are pregnant; we advise getting approval from your health care professional prior to light therapy treatment. If you are on antibiotics or suspect you have skin sensitivity issues to light, please let us know and we will perform a skin sensitivity test. I hereby affirm that I have responded to all questions honestly. I acknowledge that LightStim and RxR3 Recovery Lounge LLC service will rely on the information provided herein. I agree to update any changes to the information provided herein prior to any future treatments. I acknowledge and understand that LED light therapy treatment is not intended to diagnose, treat, cure, or prevent any disease or illness. I hereby voluntarily agree to release RxR3 Recovery Lounge LLC providing the service and LightStim, its owners, agents, and employees from any liability for any injury, loss or consequence that may arise as a result of or in connection to any LED bed treatments.
Live O2 Adaptive Contrast Trainer
Exercise with Oxygen Training | LiveO2 AC
Do NOT use Live O2 Adaptive Contrast Trainer if you have any of the following conditions. I hereby certify that I do not possess any of the following absolute contraindications on using the Equipment:
- Systemic infection, accompanied by fever, body aches, or swollen lymph glands
- Upper respiratory infections
- Arterial hypertension (i.e. systolic BP of >200mm Hg and/or a diastolic BP of >110mm Hg) at rest
- History of seizures
- Medications that decrease seizure threshold: Wellbutrin, Tramadol, High dose narcotics are the most common
- Asthma (if well controlled, you must have your inhaler with you when you use the Equipment)
- Baseline heart rate >100
- Chronic infectious disease (e.g. mononucleosis, hepatitis, AIDS, LYME)
- Pneumothorax or history of collapsed lung
- Some Selected medications or Toxins in the blood
- Oxygen Toxicity: Although rare, it may occur in prolonged oxygen exposure under high volumes.
- A recent significant change in the resting ECG suggesting significant ischemia, recent myocardial infarction (within 2 days) or other acute cardiac event
- Cardiac dysrhythmias causing symptoms or hemodynamic compromise
- Symptomatic severe aortic stenosis
- Symptomatic heart failure
- Pulmonary embolus or pulmonary infarction
- Myocarditis or pericarditis
- Suspected or known dissecting aneurysm
- Systematic infection, accompanied by fever, body aches, or swollen lymph glands
- Abnormal lung function
- Low Exercise Tolerance
- Left main coronary stenosis
- Moderate stenotic heart disease
- Electrolyte abnormalities (e.g. hypokalemia, hypomagnesaemia)
- Severe arterial hypertension (i.e. systolic BP of >200mm Hg and/or a diastolic of BP of >110mm Hg) at rest
- Tachydysrthythmia or bradydsrhythmia
- Hypertrophic cardiomyopathy and other forms of outflow tract obstruction
- Neuromuscular, musculoskeletal, or rheumatoid disorders that are exacerbated by exercise
- High-degree atrioventricular block
- Ventricular aneurysm
- Metabolic disease (e.g., diabetes, thyrotoxicosis, or myxedema)
- Chronic infectious disease (e.g. mononucleosis, hepatitis, AIDS)
- Upper Respiratory Infections
- Pacemakers (their technical specifications should be revised prior the treatment to avoid deformation)
- Seizures (and medications controlling anxiety, insomnia, agitation, seizures, etc., to be considered, i.e., benzodiazepines)
- Chronic Obstructive Pulmonary Disease (COPD) / Bullous Emphysema
- Congenital Spherocytosis – strong contraindication
- Asthma (medications to be administered to control the condition)
- Mental or physical impairment leading to inability to exercise adequately
Pulsed Electromagnetic Field (PEMF) Cellular Exerciser
I hereby request a Pulsed Magnetic Cellular Exercise session. I understand that the Pulse Centers System creates a fully adjustable pulsed magnetic field. I understand that the information shared by the demonstrator are his/her personal opinions and are intended for educational purposes only.
Product DisclaimerThe Pulse Centers System produces magnetic field energy, which passes freely through tissue for the purpose of cellular exercise to promote and support a sense of wellbeing. The FDA has not evaluated the Pulse Centers System. It is not intended for the diagnosis, treatment or cure of any medical condition. The Pulse Centers System is not a medical device and we cannot make any claims that we can affect medical conditions.
We understand this general statement regarding pulsing magnetic fields to be accurate:“PEMF (pulsed electromagnetic field) devices do not treat a specific condition. Instead they optimize the body’s natural self-healing and self-regulating function.”
– Dr. Magda Havas Associate Professor of Environmental & Resource Studies at Trent University
Contraindications: Do not use PEMF if you have the following conditions
- you have an implanted electronic device including: pacemaker, defibrillator, cochlear hearing device, spinal stimulator, etc.
- you are pregnant.
- you are actively bleeding, hemorrhaging, or during heavy menstruation
Before beginning a PEMF Exercise Session we recommend the following:
Please remove all external metal, e.g.: Electronic or battery operated devices, keys, wallets, metal belt buckles, cards with magnetic strips such as credit cards and hotel keys, jewelry, hearing aids, etc.
Regarding metal implants, they can be a sensitive area. Therefore, we recommend pulsing at a level where the user feels comfortable. If you are unsure whether pulsed magnetic cellular exercise is right for you, consult with your licensed health care provider(s)
During a PEMF Exercise Session if you experience natural reactions that include but are not limited to nausea, headache, fatigue or any uncomfortable sensations we recommend you suspend the session and consult your doctor.
Beyond what is stated above, I understand that other risks associated with a pulsed magnetic exercise session are unforeseeable 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 Pulse Centers System session. I reserve the right to use the knowledge I have gained in the care of my own body in any legal manner I may choose. I have read this form and voluntarily agree to the PEMF System session on my person assuming all liability for any and all results or consequences.
Whole Body Vibration
If any items listed below apply to you, be certain to consult with your physician before using the Power Plate equipment:
- Detached Retina
- Active Cancer
- Pregnancy (or trying to get pregnant)
For All Therapies
ALL CLIENTS: I have carefully read the above precautions and instructions for using Compression, Cryotherapy, CVAC HIIT Cell Trainer, Floatation, Infrared Sauna, Kaatsu, LiveO2 Adaptive Contrast Trainer, Whole Body Vibration. I fully understand and assume the risks associated with these sessions and fully agree to comply with these instructions. I further agree to not hold RXR3 Recovery Lounge LLC, any RXR3 Recovery Lounge LLC contractor, or any employee liable for personal or property injury, which may result from these sessions. This agreement is in effect for all sessions and will not expire unless requested by either party.
Assumption of Risks: RxR3 Recovery Lounge (“the Organizer”) oversees the training and (the “Equipment”) will be available for use by me.
I have read this Agreement and I know the nature of the Equipment. I hereby certify that a technician has adequately explained the Equipment and associated technology to me. I understand that the Equipment is not intended to be a medical device, nor is it intended to diagnose, treat, cure, or prevent any diseases.
I understand, recognize, and acknowledge that exercise using the Equipment involves an inherent risk of serious injury and/or damage.
I understand the demands associated with my usage of the Equipment relative to my physical condition and I appreciate the types of injuries, which may occur as a result of the activities made possible by my use of the Equipment. I hereby acknowledge that my usage of the Equipment is voluntary and that I KNOWINGLY ASSUME ALL RISKS involved therewith.
I have reasonably concluded that I am physically fit and have no medical condition, which would prevent my full participation and use of the Equipment. I further confirm that I am over the age of 18.
Proper hydration is critical. I acknowledge that I am responsible for ensuring that I drink enough water to remain properly hydrated as I use the Equipment.
I confirm that if I experience any pain or mental or physical discomfort at any time during my use of the Equipment, I am advised to terminate the session immediately upon my own volition, and I will advise the technician IMMEDIATELY if I feel any pain or discomfort.
I understand that the RXR3 Recovery Lounge LLC services I receive are for the basic purpose of muscular tension relief, strength building, relaxing, or stretching. If I experience any pain or discomfort during any service, I will immediately inform the therapist/instructor so that the pressure, process, position, tool, and/or movement may be adjusted to my level of comfort. I further understand that any RXR3 Recovery Lounge LLC service should not be construed as a substitute for medical examination, diagnosis, or treatment. I should see a physician or other qualified medical specialist for any mental or physical ailment that I am aware of. I understand that RXR3 Recovery Lounge LLC therapists/instructors are not qualified to perform spinal or skeletal adjustments, 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. Because Compression, Cryotherapy, CVAC HIIT Cell Trainer, Floatation, Infrared Sauna, Kaatsu, LiveO2 Adaptive Contrast Trainer, Whole Body Vibration, exercise and stretching 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 RXR3 Recovery Lounge LLC therapists and instructors updated as to any changes in my medical profile and understand that there shall be no liability on the therapist's or instructor's part should I fail to do so.
Photograph & Video Release
I hereby grant permission to the rights of my image, likeness and sound of my voice as recorded on audio or videotape without payment or any other consideration. I understand that my image may be edited, copied, exhibited, published or distributed and waive the right to inspect or approve the finished product wherein my likeness appears. Additionally, I waive any right to royalties or other compensation arising or related to the use of my image or recording. I also understand that this material may be used in diverse educational settings within an unrestricted geographic area. Photographic, audio or video recordings may be used for educational purposes, presentations, RXR3 Recovery Lounge LLC advertisements, website content, and/or social media.
By signing this form, I acknowledge that I have completely read and fully understand the above release and agree to be bound thereby. I hereby release any and all claims against any person or organization utilizing this material for any and all purposes. There is no time limit on the validity of this release nor is there any geographic limitation on where these materials may be distributed.
Waiver and Release
In consideration of the permission granted to me by the Organizer to use the Equipment today, on any future dates and on any past dates, I, on behalf of myself, my family, heirs, personal representatives and assigns (myself and the other parties, collectively the “Customer Parties”), I expressly waive and release any and all claims against RXR3 Recovery Lounge LLC, O2BFit, LLC, Impact Cryotherapy Inc, and any other equipment manufacturer, and their respective officers and its affiliates, owners, shareholders, directors, officers, employees, volunteers, independent contractors and agents and their respective successors and assigns (together with the Trainer, hereinafter collectively referred to as the “Organizer Group”) from and agree not to sue, or institute, prosecute or pursue any action concerning any claim, duty, obligation or cause of action relating to:
- Any injuries or damages of any kind whatsoever, whether presently known or unknown, suspected or unsuspected, that I may possess arising directly or indirectly from, or
- any omissions, acts, or facts that have occurred or may occur relating to, my use of the Equipment today and on any future dates, including, without limitation, any injuries that may arise, directly or indirectly therefrom.
Indemnification and Hold Harmless
In consideration of the permission granted by the Organizer to me to use the Equipment, I, on behalf of myself and the other Customer Parties also agree to INDEMNIFY, PROTECT, DEFEND AND HOLD HARMLESS THE ORGANIZER GROUP from any and all liabilities, claims, and obligations of any kind or nature whatsoever relating to my use of the Equipment today and on any future dates, including, without limitation, the negligence of any of the Organizer Group. I and the other Customer Parties further agree to reimburse the Organizer Group for any costs, fees, and expenses incurred by the Organizer Group (including reasonable attorneys’ fees) in connection with any such included claim brought by myself or the other Customer Parties, regardless of whether the claim is made in a court of law.
Acknowledgement of Understanding
I have read this entire agreement and fully understand its terms. I acknowledge that I am signing this agreement freely and voluntarily and intend my signature to signify a complete assumption of the risks of participation in the Program and use of the Property to the greatest extent allowed by law in the State of Virginia.
I agree that this Agreement is intended to be as broad and inclusive as permitted by the laws of the state of Virginia, and that this Agreement shall be governed by and interpreted in accordance with the laws of the state of Virginia.
I agree that any disputes, differences or controversies arising under this Agreement shall be settled and finally determined by arbitration, including disputes regarding the validity or enforceability of this Agreement or any part of it. The arbitration shall be conducted on a confidential basis pursuant to JAMS Comprehensive Arbitration Rules and Procedures and with the use of a JAMS arbitrator. The arbitrator shall be agreed upon by the parties. If the parties are unable to agree on an arbitrator, each party shall select one arbitrator and those two arbitrators shall agree on a third arbitrator to serve as a panel of three arbitrators. Any decision or award as a result of any such arbitration proceeding shall be in writing and shall provide an explanation for all conclusions of law and fact and shall include the assessment of costs, expenses, and reasonable attorneys’ fees. The parties reserve the right to object to any individual who shall be employed by or affiliated with a competing organization or entity. An award of arbitration may be confirmed in a court of competent jurisdiction.
I expressly agree that arbitration as provided herein shall be the exclusive means for determination of all matters arising in connection with this Agreement and neither party hereto shall institute any action or proceeding in any court of law or equity other than to request enforcement of the arbitrators’ award hereunder. The foregoing sentence shall be a bona fide defense to any action or proceeding instituted contrary to this Agreement.
I further understand that I am giving up substantial rights, including my right to sue the Owners and Operators Group in connection with my participation in the Program and use of the Property. I acknowledge that I am signing this agreement freely and voluntarily and intend my signature to be a complete and unconditional release of all liability to the Owners and Operators Group regarding the subject matter hereof to the greatest extent allowed by law in the State of Virginia.
I understand that this Agreement contains the entire agreement between myself and the Organizer. In using the Equipment, I am not relying on any collateral agreements or representations, written or oral, that are not contained in this Agreement.
The provisions of this agreement are intended to comply with applicable law. If, however, a court determines that any provision is unenforceable, then such provision shall be reformed as necessary to comply with and be enforceable under applicable law. If a court determines that any provision of this agreement is unenforceable and cannot be reformed, then such provision shall be deemed eliminated from this agreement to the extent necessary to permit the remaining provisions of this agreement to be enforced.
- I have reasonably concluded that I am physically fit and have no medical condition, which would prevent my full use of the Equipment.
- I am over the age of 18.
- I have completely read this Agreement
Signature of Client or Guardian:
Emergency Contact Information