Informed Consent and Liability Waiver for Cold Plunge, Sauna, and Hot Tub Services
Client Information:
Full Name: _________________________
Date of Birth: _______________
Phone Number: _____________________
Email:___________________________________
Informed Consent
I acknowledge that I am voluntarily participating in the Cold Plunge, Sauna, and/or Hot Tub services offered by Rise and Be Well + Fractalize. I understand these services may involve immersion in hot and cold water or exposure to extreme temperatures, which can cause physiological responses, including but not limited to:
Increased Heart Rate and Blood Pressure: Rapid temperature changes can impact the cardiovascular system, which may be unsuitable for individuals with certain health conditions.
Dizziness or Lightheadedness: Transitioning between hot and cold environments may affect blood pressure and circulation, possibly causing lightheadedness or fainting.
Breathing Changes: Temperature shock may temporarily affect breathing patterns, particularly for those with respiratory conditions.
Risk of Hypothermia or Overheating: Prolonged exposure to hot or cold may lead to hypothermia or overheating, especially if protocols are not followed.
I understand that it is my responsibility to disclose any known medical conditions, including cardiovascular, respiratory, circulatory, or other relevant health issues, to the Rise and Be Well + Fractalize staff prior to participating.
I confirm that I have no medical conditions or concerns that would prevent me from safely using these amenities, and I will inform staff if I experience discomfort or wish to end the session.
Assumption of Risk and Release of Liability
I fully acknowledge and accept that participation in contrast therapy (using hot and cold plunge techniques) may carry risks, including physical strain, and I accept full responsibility for any injury, illness, or damage that may result. I agree to release Rise and Be Well + Fractalize, including its owners, staff, and affiliates, from any liability arising from my participation in these services.
Safety Protocols and Compliance
I agree to follow all safety guidelines provided by Rise and Be Well + Fractalize, including recommendations on session duration, gradual transitions between hot and cold, and post-session care. I understand that failure to follow these protocols may increase my risk of adverse effects, for which I accept full responsibility.
Emergency Medical Consent
In the unlikely event of a medical emergency, I consent to receive first aid treatment from the facility staff and authorize them to seek additional medical assistance if necessary. I acknowledge that any medical costs incurred will be my responsibility.
Acknowledgment and Agreement
By signing below, I confirm that I have read and understood this Informed Consent and Liability Waiver. I voluntarily agree to all terms and conditions stated herein and waive certain legal rights, including the right to sue. I also affirm that I have had the opportunity to ask questions regarding this service and am satisfied with the information provided.
Signature: ___________________________
Date: _______________
Emergency Contact:
Name: ______________________
Relationship: _______________
Phone: ____________________