Whole Body Cryotherapy User Agreement
(Waiver & Release of Liability)
PLEASE READ CAREFULLY BEFORE SIGNING
Note: If completing as a Parent/Legal Guardian, please answer the following questions on behalf of minor child.
Primary Care Physician:
*Are you currently pregnant? Yes No
*Are You Under Medical Care For Any Reason? Yes No If yes, please explain:
*Do You Consider Yourself Healthy Enough For Whole Body Cryotherapy? Yes No
Participation in whole body cryotherapy involves exposure to extreme cold temperature for a brief period of time. Please be aware that if you experience any pain, mental or physical discomfort at any time during use of whole body cryotherapy, you should stop your whole body cryotherapy session immediately.
Medical History And Contraindications:
Please answer the following. Do not participate in whole body cryotherapy if you have any of the following conditions:
I understand that I should not participate in whole body cryotherapy if I have answered yes to any of the above contraindications. Initial here:
In addition to the contraindications listed above, you may have other conditions that make whole body cryotherapy inappropriate. Consult with your doctor or medical advisor if you have questions as to whether whole body cryotherapy is right for you. Proceeding otherwise is at your own risk.
Neither our equipment, nor our information regarding any potential benefits of using whole body cryotherapy, have been evaluated or approved by the Food and Drug Administration. Use of whole body cryotherapy is not intended to diagnose, treat, cure or prevent any disease. You acknowledge you are proceeding with whole body cryotherapy based on intended fitness or aesthetic benefits, if any, and for no other reason
You have been fully informed regarding the whole body cryotherapy experience before entering the unit, including a description of safety procedures, an explanation how to terminate the session early if needed, and a review to confirm you are wearing the appropriate clothing (socks, cryo boots, and gloves that are dry). You have removed all jewelry below the neck level. You are comfortable with the clothing appropriate for whole body cryotherapy. You have been advised about rotating your body ¼ or ½ turn every 30 seconds to help ensure consistent skin temperatures from ankles to shoulders. You have tested the exit mechanism for the whole body cryotherapy unit door and you are comfortable with how to quickly exit the unit should you feel any reason to do so, at any time, during your maximum of three (3) minutes in the whole body crytotherapy unit.
Unless you are an elite athlete familiar with ice baths or other forms of cryotherapy, please ensure your whole body cryotherapy session is set at Level 1during your first session. If you instruct staff to set your whole body cryotherapy to Level 2 or 3, you do so at your own risk. You should only increase to Level 2 and above after you have prior whole body cryotherapy sessions without any negative reactions or consequences at Level 1.
1. You must follow all instructions given to you by the attendant.
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). By signing this Agreement you confirm that you are in good health, you honestly filled out the medical history and contradiction above and confirmed your feel healthy enough to proceed, and you do not have any of the contraindications identified above, or other physical condition, that would preclude you from safely using whole body cryotherapy.
3. You agree that 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. You acknowledge that no representations or claims were 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 or promised. Every participant is different and responds differently and there are risk associated with this therapy. Your clothing, particularly your hands and feet, must be dry. You must avoid inhaling nitrogen fumes. Abnormal skin sensitivity to cold can be caused by certain foods, medications (including high blood pressure medications and tranquilizers), cosmetics, or conditions. Fluctuations of blood pressure are possible. It is possible to have an allergic reaction to cold and anxiety is possible. Latent viral infections (ex: cold sores) may be activated unintentionally. It is possible that due to increased energy levels, there may be an increase in restlessness at night. Consult your physician if you have any questions or concerns.
Participant Waiver and Release:
1. This is a release of liability and a waiver of certain legal rights.
2. By signing this Agreement you:
- acknowledge that use of whole body cryotherapy involves risk of bodily injury, illness, disability or death, which may be compounded by negligent emergency response of attendants or staff. You acknowledge that you are voluntarily participating in whole body cryotherapy with knowledge of the dangers involved, and accept and assume all risks of injury, illness, disability or death, whether caused by the condition of the facilities or equipment or the negligence of the attendant or otherwise. You acknowledge that frostbite is a specific risk that you assume.
- expressly waive and release any and all claims against IMPACT Cryotherapy, Inc. and Water Versatility Fitness, LLC d/b/a Cryo Wave (collectively for the purpose of this Agreement “Companies”) and Companies’s owners, shareholders, members, managers, officers, directors, employees, agents, affiliates, successors and assigns (Companies and the referenced persons are collectively referred to as “Released Parties”) arising out of or attributable to your use of whole body cryotherapy. You covenant not to assert any such claims against Released Parties, and forever release and discharge Released Parties from any liability for such claims.
California Civil Code Section 1542 states: “A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor.”
By your initials, you hereby confirm that you waive any benefit from California Civil Code Section 1542 and fully release Released Parties from any and all claims, known or unknown, arising out or related to any products, services or equipment connected with Released Parties or whole body cryotherapy.
- indemnify and hold harmless Released Parties from any loss, liability, damage, cost or expense arising out of or connected in any manner with your use of whole body cryotherapy.
- agree that this waiver and release is intended to be as broad and inclusive as permitted under applicable law.
1. This Agreement shall be construed and interpreted as broadly as possible under the laws of the State of California, excluding choice of law principles.
2. If any portion of this Agreement is held invalid, the remainder shall not be affected and shall continue in full legal force and effect.
3. The terms of this Agreement shall continue from this date forever and shall apply to each use by you of whole body cryotherapy, without the need for you to re-execute this Agreement.
4. This Agreement constitutes the entire agreement regarding your use of whole body cryotherapy and any products, services or equipment connected with Released Parties and/or Company, and supersedes all prior discussions, agreements, or representations about the use, benefits or risks of whole body cryotherapy. This Agreement may only be modified in a writing signed by you and an authorized representative of Company.
PARENTAL CONSENT FOR MINORS UNDER THE AGE OF 18 (if applicable)
If participant is under 18 years of age, parental consent is required. Participants must be a minimum of 13 years of age to use whole body cryotherapy.
I (Parent or Legal Guardian’s Name): , acknowledge that I have read this Agreement and I fully understand its contents and voluntarily agree to all terms for my minor child.
BY SIGNING BELOW YOU CONFIRM THAT YOU HAVE CAREFULLY READ BOTH PAGES OF THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS, VOLUNTARILY AGREE TO EACH OF ITS TERMS AND PROVISIONS, AND SIGN OF YOUR OWN FREE WILL.
Participant or Parent/Legal Guardian Signature: