Compression consent forms

CONSENT AND DISCLAIMER

Please fill out the following form
in order to participate in our activity.

First name

Last name

Date of Birth

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

* Did you RECENTLY do any of the following?

Sunbath or Tanning Bed

Local Anesthetic

New Tattoo or New Piercing

Beauty Treatments (slimming, liposuction, silicone implants, Botox, fillers)

Cupping, Acupuncture

Applied Body Lotion, Oil or any Skin Care product in the Last Hour

RELEASE AND WAIVER OF LIABILITY In consideration of being permitted by The Winning Culture to use any of their services, I hereby release, waive, discharge, and hold harmless The Winning Culture, its offices, employees and contractors from any and all claims, liability, demands, actions and causes of action whatsoever arising out of or related to any loss, damage injury that may be sustained while using the services/products/equipment or due to the use of such. I hereby confirm that no warranty or guarantee has been made to me covering the results of the The Winning Culture services or products. I fully understand the administration of the process including possible adverse reactions, side effects, or other possible complications. It is understood that this consent is being given in advance of any administration of the process/service. I am fully aware of the risks and hazards connected with the The Winning Culture products/services, including the risk of skin irritation and other injuries. I am voluntarily participating in the use of the services and voluntarily assume full responsibility for any risk of loss, property damage or personal injury that may be sustained. It is my express intent that this Release and Waiver of Liability Agreement shall bind the members of my family and my heirs, assignees and personal representatives. My signature below constitutes my acknowledgement that The Winning Culture services have been fully satisfactorily explained to me and I hereby give my authorization and consent to The Winning Culture to proceed with the treatments. This Release and Waiver of Liability Agreement shall stand as long as I use the services/products at The Winning Culture premises now and in the future. I have read the instructions for proper use of the facilities and do so at my own risk.

CLIENT SIGNATURE By signing this document, I acknowledge and represent that I have read, fully understand, and agree with all of the above. I am at least sixteen (16) years of age, fully competent and signing this document voluntarily. Furthermore, I agree that I will comply with all instructions on the use of the equipment and that I am using The Winning Culture services at my own risk. I agree to use services within the terms and conditions of this document and understand that refunds are not given on unused single treatments nor unused packages/memberships.

SIGN / Type your name below

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Compression consent forms

CONSENT AND DISCLAIMER

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