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SERVICE AGREEMENT AND HEALTH INTAKE FORM

WELCOME TO PROJECT WELLBEING!
This form is specifically intended for clients who are participating in a scheduled service, session, or assessment with our practitioners. Please complete all sections carefully so that we can provide the safest and most effective care possible.

PLEASE COMPLETE ALL SECTIONS CAREFULLY BEFORE SIGNING
(Note: Required fields must be filled out. If a question does not apply to you, please type "N/A")

SECTION 1: BOOKING & SERVICE CANCELLATION POLICY

Project Wellbeing is committed to providing exceptional care and high-performance services. To ensure our practitioners' schedules are managed effectively and all clients have access to care, we strictly enforce the following policies.

1. Booking & Scheduling: Appointments may be scheduled through the designated platform (app or front desk). Availability is not guaranteed and is subject to change. I am responsible for managing my bookings.
2. Credit Card Requirement: To secure and finalize any appointment at Project Wellbeing, a valid credit card must be kept on file. No appointments will be placed on the schedule until a valid form of payment is secured. By providing my credit card information, I authorize Project Wellbeing to charge my account for any late cancellations, late arrivals, or no-shows as outlined below.
3. Same-Day Cancellation Policy: We understand that schedules can change; however, because our providers' time is dedicated to a specific session, we require notice for any changes. Late Cancellation: Any appointment cancelled or rescheduled on the same day as the scheduled service will be charged 100% of the service fee. Advance Notice: Cancellations made at least one calendar day prior to the appointment will not incur a fee.
4. Late Arrival Policy (15-Minute Rule): Punctuality is essential for the quality of treatment and the flow of our facility. 15-Minute Grace Period: If I arrive late, my session will still end at the originally scheduled time so as not to delay the next client. Automatic Cancellation: If I am 15 minutes late or more for my appointment, the session will be automatically cancelled to maintain the facility schedule. Late Fee: In the event of an automatic cancellation due to a 15-minute late arrival, I will be charged 100% of the scheduled service fee.
5. No-Show Policy: A "No-Show" is defined as a client who misses a scheduled appointment without any prior notification to the facility. Failure to show up for a scheduled appointment will result in a charge of 100% of the service fee.
6. Applicable Services: These policies apply to all Project Wellbeing services, including but not limited to: Physical Therapy, Private Training, Massage Therapy, and Performance & Health Assessments.
7. Valid Cancellation Methods: To avoid a same-day cancellation fee, I must notify the front desk by calling 702-483-7262 or emailing info@projectwellbeing.co no later than the close of business on the day before my appointment.

Acknowledgment: I acknowledge and agree to the Booking & Service Cancellation Policy.

SECTION 2: GENERAL INFORMATION & SYMPTOMS

What is your main reason for your visit today (e.g., Physical Therapy, Personal Training, Massage, Assessment)?

What specific goals would you like to achieve from your sessions/services?

If applicable, how and when did your symptoms or discomfort begin?

If applicable, where are your symptoms located? (Please describe below or mark on provided clinic figures):

If applicable, how long have you had these symptoms?

Are you currently, or have you ever been, under medical supervision for the issue(s) bringing you in today?

Have you had any medical tests for this issue (such as X-rays, MRI, or CT Scans)?
Description and Date of Last X-ray:
Description and Date of Last MRI:
Description and Date of Last CT Scan:

Describe the symptoms (Please check all that apply):

What makes the symptoms better or worse?

On a scale of 0-10 (with 10 being the most severe imaginable discomfort), what is your discomfort level right now?

What time of the day is the pain or discomfort worse?

Do you have trouble sleeping? Yes No
If yes, what position do you sleep in?

SECTION 3: PHYSICAL FACTORS

What physical activities are you currently involved in?

Do you stretch now? Yes No

Have you ever had Chiropractic treatment? Yes No
If yes, how long, how often, and with whom?

Have you ever seen a Naturopathic doctor? Yes No

Have you experienced any kind of bodywork before (i.e., massage, acupuncture, etc.)? Yes No
If yes, what type?

Do you wear any type of supportive braces anywhere? Yes No

Do you wear orthotics? Yes No
If yes, for how long?

What percentage of your day is spent:
Sitting? % Standing? % Driving? %

Are your symptoms worse at the end of the workday? Yes No

Does your workstation give you support and encourage good posture? Yes No

How would you rate your own posture?

SECTION 4: MEDICAL HISTORY

Please list any recent injuries, illnesses, or surgeries (or type N/A):

Are you currently under the care of a physician? Yes No
If yes, please explain:

List current medications (including aspirin, ibuprofen, etc.) or type N/A:

Please list any allergies (or type N/A):

Conditions Checklist (Please check all that apply):

Have you had any accidents (auto or other)? Yes No
Have you ever had any major surgeries? Yes No
Have you ever had a head injury? Yes No
Have you noticed dizziness? Yes No
Change in hearing? Yes No
Change in vision? Yes No

Are there any other medical conditions your practitioner or trainer should be aware of?

Are you pregnant? Yes No
If yes, how far along are you?

Have you had, or are currently receiving cortisone/steroid shots? Yes No
If yes, when was the most recent one?

Additional Considerations:

Currently under physician care
Taking medications that may affect physical activity or recovery
Sensitivity to heat, cold, or pressure
None

Acknowledgment: I confirm that the information provided in Sections 2-4 is accurate to the best of my knowledge, and I agree to update Project Wellbeing staff if any of the above conditions change.

SECTION 5: PAR-Q (PHYSICAL ACTIVITY READINESS QUESTIONNAIRE)

Question	Yes	No
1. Has a physician ever said I have a heart condition and recommended only medically supervised activity?
2. Do I feel pain in my chest during physical activity?
3. In the past month, have I experienced chest pain when not exercising?
4. Do I lose balance due to dizziness or have I lost consciousness?
5. Do I have a bone or joint problem that could worsen with physical activity?
6. Am I currently taking medication for blood pressure or a heart condition?
7. Am I aware of any other reason I should not participate in physical activity?

If I answered YES to any of the above: I acknowledge that I may be advised to seek clearance from a licensed medical professional prior to participation.

Acknowledgment: I understand and agree to the PAR-Q terms.

SECTION 6: PHI/HIPAA AGREEMENT

Project Wellbeing is committed to protecting my personal and health-related information.

1. Information We May Collect: In the course of providing services, we may collect personal identification information, health-related information, and service history/usage data. This information is used solely to provide safe and appropriate services, improve my experience, and maintain accurate internal records.
2. Use & Protection of Information: My information will be stored securely within Project Wellbeing systems, accessed only by authorized staff when necessary, and used strictly for operational, wellness, and service-related purposes. Project Wellbeing does not sell or share my personal or health information for marketing or third-party purposes.
3. Limited Sharing of Information: My information may be shared only when necessary with internal staff directly involved in my care or services, with licensed professionals (e.g., physical therapists) when applicable, or when required by law or legal process.
4. Not a Medical Provider in All Services: I understand that not all services provided at Project Wellbeing are medical in nature. Staff such as Member Service Associates and Wellness Attendants do not provide medical advice, diagnosis, or treatment.
5. My Rights: I have the right to request access to my information, request corrections to inaccurate information, and withdraw consent for certain uses where applicable.

Acknowledgment: I acknowledge and agree to the Privacy & PHI terms above.

SECTION 7: LIABILITY RELEASE

By signing this agreement, I acknowledge that participation in fitness, wellness, and recovery services involves inherent risks.

I understand and agree that activities may involve physical exertion, equipment use, and exposure to varying environmental conditions (heat, cold, pressure, etc.). Injuries may occur, including but not limited to muscle strain, sprains, dizziness, or more serious conditions. I voluntarily assume all risks associated with participation.

To the fullest extent permitted by law, I agree to release and hold harmless Project Wellbeing, its owners, employees, contractors, and affiliates from any and all claims, liabilities, damages, or expenses arising out of my participation. This includes claims arising from use of equipment or modalities, participation in training, therapy, or recovery services, and negligence to the extent permitted by law.

I acknowledge that I may stop any activity at any time and am responsible for my own level of participation.

Acknowledgment: I agree to the terms of the Liability Release.

SECTION 8: LOCKERS AND PERSONAL PROPERTY AGREEMENT

Project Wellbeing provides lockers as a courtesy for the convenience of its members and guests. By utilizing these facilities, the Participant agrees to the following terms regarding their personal property:

Day-Use Only Policy: Lockers are provided for day-use only while the Participant is actively utilizing the facility. No Overnight Storage: Storing personal items in lockers overnight is strictly prohibited. Lock Removal: Any locker found to be occupied after the facility has closed for the business day will be opened by staff. Project Wellbeing reserves the right to cut or remove any personal locks at the Participant's expense.
Abandoned Property & Friday Disposal: To maintain facility hygiene and locker availability, Project Wellbeing enforces a strict weekly "clear out" policy. Lost and Found: Any items removed from lockers or found left unattended on the facility floor will be placed in the designated Lost and Found. Disposal Schedule: All items remaining in the Lost and Found will be disposed of, donated, or destroyed every Friday at closing. Project Wellbeing is not responsible for notifying Participants before disposing of abandoned items. It is the sole responsibility of the Participant to claim their property before this weekly deadline.
Limitation of Liability: Project Wellbeing is a facility and cannot guarantee the security of personal belongings. Valuables: Participants are strongly discouraged from bringing high-value items (including but not limited to jewelry, large sums of cash, or expensive electronics) into the facility. Assumption of Risk: The Participant assumes all risk of loss, theft, or damage to any personal property brought onto the premises, including items stored in lockers, the recovery lounge, or left in the parking area. Release: Project Wellbeing, its owners, and its employees shall not be held liable for the loss, theft, or destruction of, or damage to, any personal property of the Participant or their guests.
Prohibited Items: Participants may not store any hazardous materials, illegal substances, perishable food items, or damp/soiled clothing in lockers for extended periods.

Acknowledgment: I acknowledge and agree to the Lockers and Personal Property Agreement terms.

SECTION 9: RECOVERY MODALITY WAIVER

I acknowledge that I am voluntarily using the recovery services provided by Project Wellbeing. I understand the specific risks associated with each modality listed below and certify that I have consulted a physician regarding my ability to use them. I understand that access to specific recovery modalities depends on the specific membership, pass tier purchased, or service booked.

General Aquatic Hygiene & SNHD Compliance (Cold Plunge & Hot Mineral Soak Tub)
By utilizing the aquatic vessels at Project Wellbeing, Participant agrees to adhere to all Southern Nevada Health District (SNHD) regulations, including but not limited to the following:

Hygiene: Participants MUST take a cleansing shower before entering any aquatic vessel.
Illness: Participant confirms they do not currently have, nor have they had in the past 14 days, diarrhea or any communicable disease.
Wounds: Participant confirms they do not have any open wounds, cuts, sores, or skin infections.
Medical Conditions: Pregnant women, elderly persons, and persons suffering from heart disease, diabetes, or high/low blood pressure should not enter the Hot Mineral Soak Tub without prior medical consultation.
Facility Rules: Participant agrees not to swallow or spit water, urinate, or defecate in the vessels. No glass items of any kind are permitted near the aquatic areas.

A. Cold Plunge: Risks: Hypothermia, cold shock response, slip and fall on wet surfaces. Contraindications: I confirm I do not have uncontrolled high blood pressure, heart disease, or sensitivity to extreme cold.

B. High Heat Sauna & Infrared Sauna: Risks: Dehydration, heat exhaustion, heat stroke, dizziness, fainting, burns. Contraindications: I confirm I am not pregnant, dehydrated, under the influence of alcohol, or suffering from low blood pressure or heart conditions.

C. Hot Mineral Soak Tub: Risks: Dehydration, dizziness, skin irritation, slip and fall. Contraindications: I confirm I do not have severe dehydration or heart conditions sensitive to heat.

D. Red Light Bed (Photobiomodulation): Risks: Eye strain or damage if proper eyewear is not worn. Contraindications: I confirm I am not taking photosensitizing medications and do not have a history of seizures triggered by light.

E. Molecular Hydrogen Therapy: Risks: Dizziness or lightheadedness from inhalation.

F. Normatec Compression: Risks: Discomfort from pressure, circulatory issues if used improperly. Contraindications: I confirm I do not have acute pulmonary edema, deep vein thrombosis (DVT), or acute congestive heart failure.

G. Vibroacoustic Therapy: Risks: Disorientation or motion sickness sensitivity. Contraindications: I confirm I do not have a pacemaker, recent surgery/implants that may be affected by vibration, or acute thrombosis.

H. Cryotherapy Chamber: Risks: Frostbite (cold burns), fainting/lightheadedness, rapid blood pressure increase, claustrophobia. Contraindications: I confirm I do not have untreated hypertension, heart conditions (angina, pacemaker), Raynaud's syndrome, or cold allergies. I confirm I am wearing dry socks and protective gear as instructed by Project Wellbeing staff.

I. Medical Multilight Bed: Risks: Intense light exposure, thermal discomfort, skin sensitivity reactions. Contraindications: I confirm I do not have epilepsy, active cancers/tumors (unless cleared by a physician), or use photosensitive medications.

J. PEMF Mat (Pulsed Electromagnetic Field): Risks: Magnetic interference with electronic devices, mild nausea or dizziness. Contraindications: I confirm I do not have an implanted electrical device (pacemaker, defibrillator/ICD, cochlear implant, insulin pump), am not pregnant, and do not have active bleeding or hemorrhage.

K. Hyperbaric Oxygen Therapy (HBOT): Pressure & Ear Safety: I understand that changes in pressure can cause ear/sinus pain or rupture if I cannot equalize pressure. I agree to alert staff IMMEDIATELY if I experience ear pain. I affirm I currently have no congestion, cold, flu, or sinus infection. Fire Hazard & Prohibited Items: I certify that I have REMOVED ALL prohibited items including: lighters, matches, vapes/e-cigarettes, hand warmers, battery-operated devices, and petroleum-based lotions/products. Contraindications: I confirm I do not have an untreated pneumothorax (collapsed lung), severe COPD, or bullous emphysema.

L. RASHA Dome (Scalar Plasma Technology): Scalar & Plasma Risks: I acknowledge the potential for a "Herxheimer Reaction" (detoxification symptoms). Electrical Sensitivity: I confirm I do NOT have any implanted electrical devices or cochlear implants. Sobriety Requirement: I confirm I am NOT under the influence of recreational drugs, alcohol, or mind-altering medications. Contraindications: I confirm I am not pregnant, do not have a history of seizures, and have not had an organ transplant.

Acknowledgment: I understand and accept all risks associated with these modalities.

SECTION 10: FINAL ACKNOWLEDGMENT

I agree to pay my account with this office in accordance with the regular rates and payment terms. I understand that if I do not give advanced notice of cancellation by the close of business the day prior, I will be charged for the appointment unless it can be filled. Emergency cancellations will be determined by the owner.

I HAVE READ THIS ENTIRE AGREEMENT, FULLY UNDERSTAND ITS TERMS, AND SIGN IT FREELY AND VOLUNTARILY WITHOUT ANY INDUCEMENT.

Acknowledgment: I acknowledge that I have read, understood, and agree to be bound by all the terms, conditions, and policies outlined in this entire Service Agreement and Health Intake Form.

Name of Adult Participant and/or Parent or Legal Guardian of Minor:

First Name:	Last Name:	Birth Date:
Address:	City:	State:
Zip:	Email:	Phone:

Relationship to minor:

Full Name and Birth Date of family members under the age of 18

#1	First Name:	Last Name:	Birth Date:
#2	First Name:	Last Name:	Birth Date:
#3	First Name:	Last Name:	Birth Date:
#4	First Name:	Last Name:	Birth Date:
#5	First Name:	Last Name:	Birth Date:
#6	First Name:	Last Name:	Birth Date:
#7	First Name:	Last Name:	Birth Date:
#8	First Name:	Last Name:	Birth Date:
#9	First Name:	Last Name:	Birth Date:
#10	First Name:	Last Name:	Birth Date:

Date and Time Signed:

By checking this box I agree to have read and agree to the legal agreement above.

Send me emails about Account Management, Reminders, and Schedule Changes

Send a copy of this waiver to my email

Our Privacy Policy

PLEASE NOTE THAT WAIVERKING, INC.’S (“WaiverKing”) PRIVACY POLICY HAS CHANGED EFFECTIVE May 25th, 2018.

You acknowledge that this privacy policy is a part of our website’s Terms of Service, and by accessing or using our website, you agree to be bound by all of its terms and conditions. IF YOU DO NOT AGREE TO THESE TERMS, AS UPDATED, PLEASE IMMEDIATELY STOP ACCESSING THE WEBSITE.

This document explains how we use your personal data.

When you sign up to use this service provider’s services, you do so through software provided by us, WaiverKing.

We are committed to ensuring the privacy of all users of our software and services and other visitors to our website. In this policy we explain how we hold, process and retain your personal data.

In respect to the account data, waiver data, and payment data (as defined below) that you provide to us, we are acting as a data processor on behalf of the service provider, who will be acting as the data controller in respect to such data. We will never store or control this data. You should direct any requests or queries you have regarding this data to the data controller, your service provider.

1. How we use your personal data

1.1. This section provides you with information about:

a) what personal data we hold and process;

b) in respect of personal data that we did not collect from you directly, where we obtained that data from, and what types of data we have collected;

c) the purposes for which we may process your personal data; and

d) the legal grounds on which we process your data.

Members and end users of our services

1.2. Account data. We may process information about you that you provide to us when you first sign up with a service provider ("account data"). This account data may include your name, address, telephone number, email address, date of birth, gender, employment details, and a photograph of you. We may use this data to create your account with the service provider when you sign up. This account data may be updated each time you complete a document through our software. We do not process your account data in any other way, or have access to it in any way.

The legal basis for this processing is our legitimate interests in providing our services to our clients, and ensuring that your account is updated each time that you complete a document through our software.

1.3. Waiver data. If you are using our software in order to sign documents such as a waiver, health form, contract, or questionnaire, we may process information that you put into such documents (“waiver data”). This waiver data may include your name, signature, date of birth, email address, information about your health and medical history, and any other information that you are required or requested to put into the document.

Once you have completed the document, we will process it, convert the document into a different format, and send it to your account with the service provider in order for it to be stored. We will never store your data permanently on our systems (although it may be stored in your account with your service provider).

The purpose for our processing your data in this way is to maintain and administer a complete and accurate record of the documents that you have signed and completed for your service provider. The legal basis for our processing your waiver data (to the extent that such waiver data does not class as a special category of personal data), will be our legitimate interests in providing our services to our clients who have asked you to complete the document in question, in order to ensure that a complete and accurate record of your signing and completing the documents is maintained and administered.

1.4. Sensitive Personal Data. During the course of using our software and services and providing us with information in order for us to provide our services to you, you may provide us with sensitive information about yourself (“sensitive data”). This sensitive data may include your health and medical history. We may use this data for providing our services to you. However, we will only process this sensitive data if you consent to us doing so.

[The consent to use this information needs to be provided by the parent for children under the age of 13. Anyone over the age of 13 can provide consent for use of their data under GDPR]

We comply with the requirements of the Children’s Online Privacy Protection Act. You must be at least 18 years old to have our permission to use the WaiverKing website. If you are between the ages of 13 and 17, or under the age of majority where you live, you represent that your legal guardian has reviewed and agreed to this privacy policy.

Other processing that we may carry out

1.5. Website data. We may process data about your use of our website and services ("website data"). The website data may include your IP address, geographical location, browser type and version, operating system, referral source, length of visit, page views and website navigation paths, as well as information about the timing, frequency and pattern of your service use. The source of the website data is our analytics tracking system. This website data may be processed for the purposes of analyzing the use of the website and services.

The legal basis for this processing is our legitimate interests, namely monitoring and improving our website and services.

We may also process this data for the purposes of diagnosing any issues we detect in relation to the use of our products or services. This data may be collected by our error-tracking software which is provided by Rollbar. We always try to ensure that any such data is anonymized so that you cannot be identified before it is stored in our records.

The legal basis for this processing is our legitimate interests in monitoring and improving our products and services.

1.6. Enquiry data. We may process information contained in any enquiry you submit to us regarding our products or services ("enquiry data"). The enquiry data may be processed for the purposes of offering, marketing and selling relevant products and/or services to you.

The legal basis for this processing is our legitimate interests, namely dealing with and responding to your enquiry appropriately.

1.7. Notification data. We may process information that you provide to us for the purpose of subscribing to our blog and press releases ("notification data"). The notification data may be processed for the purposes of sending you newsletters.

Where you are a corporate customer, the legal basis for this processing is our legitimate interests, namely the marketing of relevant products and services to you.

1.8. Correspondence data. We may process information contained in or relating to any communication that you send to us ("correspondence data"). The correspondence data may include the communication content and metadata associated with the communication. Our website will generate the metadata associated with communications made using the website contact forms. The correspondence data may be processed for the purposes of communicating with you and record-keeping.

The legal basis for this processing is our legitimate interests, namely the proper administration of our website and business and communications with users.

1.9. Payment data. We do not process payment information relating to goods and services that you purchase from the service provider. However, we do capture certain data relating to your payments and use them to update your account with the service provider ("payment data"). The payment data may include your contact details, your card details and the transaction details. The payment data may be processed for the purposes of updating your account with the service provider. The legal basis for this processing is our legitimate interests, namely our interest in the proper administration of our software and ensuring your account with the service provider is updated.

1.10. Other processing activities. In addition to the specific purposes for which we may process your personal data set out above, we may also process any of your personal data where such processing is necessary for compliance with a legal obligation to which we are subject, or in order to protect your vital interests or the vital interests of another natural person.

2. Providing your personal data to others

2.1. To our clients and partner service providers. The only third parties that we will disclose your personal data to are our clients (your service provider) who is the data controller in respect to the account data, waiver data, and payment data that we collect about you, and MINDBODY Inc. (“MINDBODY”), who provide software services to service providers in conjunction with the WaiverKing software. Your accounts are created by WaiverKing in the MINDBODY software on behalf of our clients.

2.2. Our insurers/professional advisers. We may disclose your personal data to our insurers, legal counsel, and/or professional advisers insofar as reasonably necessary for the purposes of obtaining and maintaining insurance coverage, managing risks, obtaining professional advice and managing legal disputes.

2.3. Where we provide your personal data to any third party. Where we share your personal data with any of the third parties referred to above, we will ensure this processing is protected by appropriate safeguards including a suitable data processing agreement with that third party.

2.4. To comply with legal obligations. In addition to the specific disclosures of personal data detailed above, we may also disclose your personal data where such disclosure is necessary for compliance with a legal obligation we have to comply with, or in order to protect your vital interests or the vital interests of another individual. This may include disclosing your personal data in response to lawful requests by public authorities, including to meet national security or law enforcement requirements.

2.5. We take reasonable and appropriate steps to ensure that third-party agents and service providers process your personal data in accordance with our Privacy Shield obligations and to stop and remediate any unauthorized processing. Under certain circumstances and pursuant to applicable laws, we may remain liable for the acts of our third-party agents or service providers who perform services on our behalf for their handling of your personal data that we transfer to them.

3. Transfers of your personal data outside of the European Economic Area

As further detailed below, we may transfer your personal data to our servers based in the US, as we are part of the Privacy Shield. Otherwise, where your personal data is transferred outside of the EEA, we will ensure that either (a) The European Commission has made an "adequacy decision" with respect to the data protection laws of the country to which it is transferred, or (b) we have entered into a suitable data processing agreement with the third party situated in that country to ensure the adequate protection of your data. In all cases, transfers outside of the EEA will be protected by appropriate safeguards.

4. Retaining and deleting personal data

4.1. Personal data that we process for any purpose or purposes shall not be kept for longer than is necessary for that purpose or those purposes. Details about members of our clients (your service provider) and end users of our services, including the account data, waiver data and sensitive personal data, will not be stored by WaiverKing.

4.2. Unless we contact you and obtain your consent for us to retain your personal data for a longer period, we will retain and delete your personal data as follows:

a) Website data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

b) Enquiry data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

c) Notification data (other than Notification data that is also Contact data) will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

d) Correspondence data will be retained for 12 months following the date of our last contact or dealing with you, at the end of which period it will be deleted from our systems.

4.3. We may retain your personal data where such retention is advisory and/or necessary for compliance with a legal obligation to which we are subject (such as with regard to applicable statutes of limitations, litigation or regulatory investigations), or in order to protect your vital interests or the vital interests of another natural person.

5. Your rights

5.1. You may instruct us to provide you with any personal information we hold about you; provision of such information will be subject to:

a) your request not being found to be unfounded or excessive, in which case a charge may apply; and

b) the supply of appropriate evidence of your identity (for this purpose, we will usually accept a notarized photocopy of your driver’s license and/or passport and an original copy of a utility bill showing your current address).

5.2. We may withhold personal information that you request to the extent permitted by law.

5.3. You may instruct us at any time not to process your personal information for marketing purposes.

5.4. In practice, you will usually expressly agree in advance to our use of your personal information for marketing purposes, or we will provide you with an opportunity to opt out of the use of your personal information for marketing purposes.

5.5. Your right to access your data. You have the right to ask us to confirm whether or not we process your personal data and, to have access to the personal data, and any additional information. That additional information includes the purposes for which we process your data, the categories of personal data we hold and the recipients of that personal data. You may request a copy of your personal data. The first copy will be provided free of charge, but we may charge a reasonable fee for additional copies.

5.6. Your right to correct. If we hold any inaccurate personal data about you, you have the right to have these inaccuracies corrected. Where necessary for the purposes of the processing, you also have the right to have any incomplete personal data about you completed.

5.7. Your right to erasure. In certain circumstances you have the right to have personal data that we hold about you erased. This will be done without undue delay. These circumstances include the following: (1) it is no longer necessary for us to hold those personal data in relation to the purposes for which they were originally collected or otherwise processed; (2) you withdraw your consent to any processing which requires consent; (3) the processing is for direct marketing purposes; and/or (4) the personal data have been unlawfully processed. However, there are certain general exclusions of the right to erasure, including where processing is necessary: for exercising the right of freedom of expression and information; for compliance with a legal obligation; or for establishing, exercising or defending legal claims.

5.8. Your right to restrict processing. In certain circumstances you have the right for the processing of your personal data to be restricted. These circumstances include the following: (1) you do not think that the personal data we hold about you is accurate; (2) your data is being processed unlawfully, but you do not want your data to be erased; (3) it is no longer necessary for us to hold your personal data for the purposes of our processing, but you still require that personal data in relation to a legal claim; and/or (4)you have objected to processing, and are waiting for that objection to be verified. Where processing has been restricted for one of these reasons, we may continue to store your personal data. However, we will only process it for other reasons: with your consent; in relation to a legal claim; for the protection of the rights of another natural or legal person; or for reasons of important public interest.

5.9. Your right to object to processing. You can object to us processing your personal data where our legal basis for the processing is that it is necessary for: the performance of a task carried out in the public interest, or in the exercise of any official authority vested in us; or the purposes of our legitimate interests or those of a third party. If you make an objection, we will stop processing your personal information unless we are able to: demonstrate compelling legitimate grounds for the processing, and that these legitimate grounds override your interests, rights and freedoms; or the processing is in relation to a legal claim.

5.10. Your right to object to direct marketing. You can object to us processing your personal data for direct marketing purposes. If you make an objection, we will stop processing your personal data for this purpose.

5.11. Your right to data portability. Where you have given us consent to process your personal data, or where we are processing your personal data for the performance of a contract, you have a legal right to receive a copy of the personal data we hold about you in a structured, commonly used and computer readable format. When a data request is made of us we will make available all applicable personal data to you in a computer readable format and will transmit your personal data to the appropriate third party pursuant to your instruction. We will not process your data in this way if we believe that it may pose a threat to the security of the data.

5.12. Your right to object for statistical purposes. You can object to us processing your personal data for statistical purposes on grounds relating to your particular situation, unless the processing is necessary for performing a task carried out for reasons of public interest.

5.13. Automated data processing. To the extent that the legal basis we are relying on for processing your personal data is consent, and where the processing is automated, you are entitled to receive your personal data from us in a structured, commonly used and computer-readable format. However, you may not have this right if it would adversely affect the rights and freedoms of others.

5.14. Complaints to a supervisory authority pursuant to the GDPR. If you think that our processing of your personal data infringes data protection laws, you can lodge a complaint with a supervisory authority responsible for data protection. You may do this in the EU member state of your habitual residence, your place of work or the place of the alleged infringement. This provision is only applicable if you are subject to the protections of the GDPR.

5.15. Complaints if you are not subject to the protections of the GDPR. If you think that our processing of your personal data infringes data protection laws you may contact us via email at privacy@waiverking.com or mail at: WaiverKing, Inc. 340 S Lemon Ave # 2018 Walnut, California 91789.

5.16. Right to withdraw consent. To the extent that the legal basis we are relying on for processing your personal data is consent, you are entitled to withdraw that consent at any time. Withdrawal will not affect the lawfulness of processing before the withdrawal.

5.17. Exercising your rights. You may exercise any of your rights in relation to your personal data by written notice to us in addition to the other methods specified above.

5.18. Point of Contact Data. PARAGRAPHS 5.1 – 5.17 SHALL NOT APPLY TO ACCOUNT DATA, WAIVER DATA, OR PAYMENT DATA OBTAINED OR PROCESSED BY WAIVERKING. IN RESPECT OF SUCH DATA:

a) WAIVERKING IS ACTING AS A PROCESSOR OF THAT DATA AND THE MAIN CONTRACTOR IS THE CONTROLLER;

b) YOU SHOULD CONTACT THE SERVICE PROVIDER TO EXERCISE THE RIGHTS SET OUT IN THIS PARAGRAPH 5

6. Links To Other Websites. Except as otherwise discussed in this privacy policy, this document only addresses the use and disclosure of information we collect from you. Other websites accessible through our website have their own privacy policies and data collection, use, and disclosure practices. Please consult each website’s privacy policy. We are not responsible for the policies or practices of third parties, including any third-party site or other products and services used in connection with WaiverKing’s services. The inclusion of a link does not imply endorsement of the linked site or service by us or by our affiliates.

We are not responsible for the collection, usage and disclosure policies and practices (including the data security practices) of other organizations, such as, Apple, Google, Microsoft, or any other operating system provider, wireless service provider or device manufacturer, including any personal data you disclose to other organizations through or in connection with WaiverKing’s services.

7. Security of Your Information. The security of personal data is a high priority at WaiverKing. We seek to use reasonable technical, administrative and physical safeguards to protect personal data within our organization. Unfortunately, no data transmission or storage system can be guaranteed to be 100% secure. As a result, while we strive to protect your personal data, you acknowledge that: (a) there are security and privacy limitations of the Internet which are beyond our control; (b) the security, integrity, and privacy of any and all information and data exchanged between you and us through the website cannot be guaranteed; and (c) any such information and data may be viewed or tampered with in transit by a third party.

8. IP Addresses and Cookies. Cookies are very small text files that are stored on your computer when you visit some websites.

We use cookies to help identify your computer, including where available, your IP address, operating system and browser type, for system administration so we can keep your activity secure, tailor your user experience and remember your preferences. This is statistical data and does not identify any individual. You are always free to decline our cookies if your browser permits, but some parts of our website may not work properly.

9. Your California Privacy Rights: Notice to California Customers and Opt-Out Information. Residents of the State of California, under certain provisions of the California Civil Code, have the right to request from companies conducting business in California a list of all third parties to which the company has disclosed certain personal data, as defined under California law, during the preceding year for third party direct marketing purposes. You are limited to one request per calendar year. In your request, you must supply appropriate evidence of your identity and attest to the fact that you are a California resident and provide a current California address for our response. You may request the information by writing to privacy@waiverking.com

Some web browsers incorporate a “Do Not Track” feature that signals to websites that you visit that you do not want to have your online activity tracked. California residents are entitled to know how WaiverKing, Inc. responds to “Do Not Track” signals. How browsers communicate the Do Not Track signal is not yet uniform, so a standard technological response has not yet been developed by the appropriate technology communities. For this reason, we do not respond to Do Not Track signals currently. To opt out of direct advertising on our website, please send a request to the address above. The effect of an opt-out will be to stop direct advertising, but it will still allow the collection of usage data for certain purposes (e.g., research, analytics, and internal online services operation purposes).

10. Privacy Shield Framework

10.1. WaiverKing Inc. complies with the EU-U.S. and Swiss-U.S. Privacy Shield Framework as set forth by the U.S. Department of Commerce regarding the collection, use, and retention of personal information transferred from the European Union and Switzerland to the United States. WaiverKing has certified to the Department of Commerce that it adheres to the Privacy Shield Principles. If there is any conflict between the terms in this privacy policy and the Privacy Shield Principles, the Privacy Shield Principles shall govern. To learn more about the Privacy Shield program, and to view our certification, please visit https://www.privacyshield.gov/

10.2. In compliance with the Privacy Shield Principles, WaiverKing commits to resolve complaints about our collection or use of your personal information. Any individual(s) with inquiries or complaints regarding our Privacy Shield policy should contact us at: privacy@waiverking.com

10.3. WaiverKing Inc. has further committed to refer unresolved Privacy Shield complaints to Judicial Arbitration and Mediation Services (JAMS), an alternative dispute resolution provider located in the United States. If you do not receive timely acknowledgment of your complaint from us, or if we have not addressed your complaint to your satisfaction, please visit https://www.jamsadr.com/eu-us-privacy-shield for more information or to file a complaint. The services of JAMS are provided at no cost to you. In certain situations, you may also have the right to pursue binding arbitration under the Privacy Shield Framework.

10.4. You may have the option to select binding arbitration for the resolution of your complaint under certain circumstances, provided you have taken the following steps: (1) raised your complaint directly with WaiverKing Inc. and provided us the opportunity to resolve the issue; (2) made use of the independent dispute resolution mechanism identified above; and (3) raised the issue through the relevant data protection authority and allowed the U.S. Department of Commerce an opportunity to resolve the complaint at no cost to you. For more information on binding arbitration, see U.S. Department of Commerce's Privacy Shield Framework: Annex I (Binding Arbitration).

10.5. For purposes of enforcing compliance with the Privacy Shield, WaiverKing is subject to the investigatory and enforcement authority of the U.S. Federal Trade Commission.

10.6. WaiverKing Inc. is controlled and operated by us from the United States. Except where you are a resident of a Member State of the EU, in which case paragraphs 2 and 3 above will apply, your personal data may be stored and processed in any country in which we engage service providers, and by using WaiverKing’s services you understand that your information may be transferred to countries outside of your country of residence, including the United States, which may have data protection rules that are different from those of your country. In certain circumstances, courts, law enforcement agencies, regulatory agencies or security authorities in those other countries may be entitled to access your personal data. Regardless of where your information is processed, we apply the same protections described in this policy.

11. Changes to the privacy policy. We reserve the right to change this policy at any time, without prior notice to you. Such changes, modifications, additions, or deletions shall be effective immediately upon notice thereof, which may be given by means including, but not limited to, issuing an e-mail to the e-mail address provided by you or posting the revised policy on this page. You acknowledge and agree that it is your responsibility to maintain a valid e-mail address and/or review the WaiverKing website and this policy periodically, and be aware of any modifications. Your continued use of the WaiverKing website after such modifications will constitute your: (a) acknowledgment of the modified policy; and (b) agreement to abide and be bound by the modified policy.

12. Our details

12.1. This website and software is owned and operated by WaiverKing Inc.

12.2. We are registered in the state of California under registration number C3518177, and our registered office is at 340 S Lemon Avenue, # 2018 Walnut, California 91789.

12.3. You can contact us:

a) by mail, using the postal address given above;

b) using our website contact form;

c) by telephone, on the contact number published on our website from time to time; or

d) by email, using the email address published on our website from time to time.

13. Data protection officer

Our data protection officer may be contacted via email: privacy@waiverking.com, or telephone: +1 (888) 211-6693.

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SERVICE AGREEMENT AND HEALTH INTAKE FORM

SECTION 1: BOOKING & SERVICE CANCELLATION POLICY

SECTION 2: GENERAL INFORMATION & SYMPTOMS

SECTION 3: PHYSICAL FACTORS

SECTION 4: MEDICAL HISTORY

SECTION 5: PAR-Q (PHYSICAL ACTIVITY READINESS QUESTIONNAIRE)

SECTION 6: PHI/HIPAA AGREEMENT

SECTION 7: LIABILITY RELEASE

SECTION 8: LOCKERS AND PERSONAL PROPERTY AGREEMENT

SECTION 9: RECOVERY MODALITY WAIVER

SECTION 10: FINAL ACKNOWLEDGMENT

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