Cryogenic Chamber 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?

* The use of the whole-body cryotherapy chamber requires the use of all below listed PPEs at the time of entering the cryo session as well as at all times during the session: • Safety shoes, Socks • Underwear (that does not have any metal components) • Bottom and top part (mandatory for female visitors • Gloves * Any body part or body surface that is exposed to nitrogen vapors must not have on it (or in it) any metal such as piercing, watch, bracelet etc. * Any body part or body surface that is exposed to nitrogen vapors must be dry.

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.

NOTICE You are free to end your session at any time during the treatment by simply advising The Winning Culture staff who is always present with you during the cryotherapy treatment to explain all treatments, guide and assist you throughout your session. Any change in your medical condition between treatments must be without delay (latest before the next session) declared to The Winning Culture staff. The Winning Culture staff reserves the right to refuse to render services in case of such a change or may require a prior written recommendation from your physician. The Winning Culture is not responsible for any of your personal belongings left behind or lost.

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.

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Cryogenic Chamber consent forms

CONSENT AND DISCLAIMER

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