The Cryo Spa New Customer Form

WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT

 

1. IN CONSIDERATION FOR USING THE CRYO DEVICE (HEREINAFTER REFERRED TO AS “EQUIPMENT”), I HEREBY RELEASE, WAIVE, DISCHARGE IN ADVANCE, and HOLD HARMLESS THE CRYO SPA, INC., ALONG WITH THE CRYO SPA, INC.’S OFFICERS (INCLUDING BUT NOT LIMITED TO) OFFICIALS, EMPLOYEES, AGENTS, FRANCHISEES and VOLUNTEERS, (ALL OF WHOM ARE REFERRED TO AS “RELEASEES”), FROM ANY AND ALL LIABILITY, CLAIMS, DEMANDS, ACTIONS, AND CAUSES OF ACTION WHATSOEVER ARISING OUT OF OR RELATED TO ANY DAMAGE OR INJURY THAT MAY BE SUSTAINED BY ME, DUE TO ANY ACT OF NEGLIGENCE OF ANY OF RELEASEES, WHILE USING ANY EQUIPMENT, DUE TO THE USE OF ANY EQUIPMENT, OR DUE TO ANY CONDITION OF ANY PREMISES OF THE CRYO SPA, INC..

2. I hereby confirm that no warranty or guarantee, or other assurance has been made to me covering the results of the cryo process. I have been explained and understand the administration of the process, including possible adverse reactions, side effects, or other possible complications. It is understood that MY CONSENT, AS INDICATED BY MY AGREEMENT BELOW, is being given in advance of any administration of the process, and is being given by me voluntarily to use any Equipment of The Cryo Spa, Inc. 

3. I am fully aware of the risks connected with the use of the Equipment, and I am voluntarily participating in said Equipment usage, and entering The Cryo Spa, Inc.’s premises to engage in such usage. I VOLUNTARILY ASSUME FULL RESPONSIBILITY FOR ANY RISKS that may be engaged in such an activity. 

4. It is my express intent that this Release and Hold Harmless Agreement shall bind the members of my family and shall be deemed as a RELEASE, WAIVER, AND DISCHARGE of the above named RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be construed in accordance with the laws of the State of Texas. 

5. I understand that the Equipment of The Cryo Spa, Inc. is designed for fitness and appearance enhancing use only by persons in good general health. I have been advised that if I suffer from any medical condition or illness whatsoever, I am NOT TO USE the Equipment without my doctor’s written permission. If I should faint due to excess nitrogen inhalation, I hold myself responsible for all injuries should I fall, and the cryosauna attendant has the right to assist me. 

6. My agreement below constitutes my acknowledgment that (1) I have read, understand, and fully agree to the foregoing CONSENT; (2) the proposed indoor cryo process has been satisfactorily explained to me and I have all of the information I desire; (3) I hereby give my authorization and consent. This CONSENT shall stand as a long as I use any Equipment of the Cryo Spa, Inc. now and in the future; and (4) that I have signed this Waiver of Liability and Hold Harmless Agreement of my own free and voluntary will, without any threat or coercion whatsoever.

Personal History

Please notify a staff member if:

  • you do not feel healthy and well at the moment
  • you are currently under medical care for any reason
  • you are pregnant
  • you have or have ever had ANY of the following:

 

Severe Hypertension (BP> 180/100), acute or recent myocardial infarction (heart attack; need to be cleared for exercise), pacemaker, arrhythmia, symptomatic cardiovascular disease, acute or recent cerebrovascular accident (stroke; need to be cleared for exercise), uncontrolled seizures, fever, symptomatic lung disorders, bleeding disorders, active cancer (undergoing chemotherapy), Raynaud’s Disease, uncontrolled hypothyroidism, infection, claustrophobia, intolerance to cold, incontinence.

O2 Aromatherapy Bar 

 

 

1. The Oxygen used at the O2 Aromatherapy Bar is not a medical device, and should be used for recreational purposes only.

2. The 02 Aromatherapy Bar uses a concentrator device that filters out oxygen from room air for delivery to the guest.

3. The air we breathe is approximately 21% oxygen. The O2 Aromatherapy Bar serves 90% pure oxygen. 

4. Oxygen generated by the O2 Aromatherapy Bar is supplemental and should not be considered life supporting or life sustaining.

5. O2 Aromatherapy Sessions last no longer than 20 minutes.

6. Anyone under the age of 17 years old must be accompanied by an adult.

 

What is Whole Body Cryotherapy?

 

Whole Body Cryotherapy is the exposure of a person’s skin to averaging temperatures of -238 to -290 degrees Fahrenheit for a short time (3 minutes or less). At this temperature, the body activates several mechanisms that have significant long-term medical and cosmetic benefits:

The outer skin reacts to the cold by activating an increased production of collagen in deeper layers of the skin (similar to laser treatments of the face, where very high temperatures are used). The skin regains elasticity and becomes smoother and even-toned, significantly improving conditions such as cellulite and skin aging.

Skin vessels and capillaries undergo severe vasoconstriction (to keep the core temperature from dropping), followed by vasodilation after the procedure. Toxins and other stored deposits are flushed out of the layers of the skin and blood perfusion is improved after several treatments.

The anti-inflammatory properties of cryotherapy are also used to treat chronic skin conditions such as psoriasis and dermatitis.

 

Local Cryotherapy

Our facility uses a liquid nitrogen-cooled device to treat shoulders, back, arms, wrists, legs, and ankles. The rapid cooling of the device operating at -160 degrees Celcius causes fast relief of pain and decreases inflammation, speeding up the healing process. Treatments last 3-6 minutes.

 

Cryofacial™

Local application of pressurized nitrogen vapors to the skin of the scalp, face, neck, and chest. The application stimulates the production of collagen and decreases pore size of the skin. Over time, skin becomes more elastic and even toned. Cryofacial™ sessions last up to 10 minutes.

 

Safety Instructions for Cryotherapy

1. You must wear cotton socks and gloves to avoid chilblain.

2. Treatments are limited to 3 minutes per session. Overexposure to the cold temperatures may cause chilblain.

3. During treatment, you must avoid inhaling the nitrogen fumes; while non-toxic, they are devoid of oxygen and may cause fainting.

4. You may end the procedure at any time if you experience any problems or anxiety.

5. Abnormal skin sensitivity to cold may be caused by certain foods, cosmetics, or medication, including but not limited to the following: Tranquilizers, High blood pressure medication.

6. A person who is less than (18) years of age may not use whole body cryotherapy without parental consent.

7. You will be observed by a technician the entire time while in the chamber, but are free to walk out at any time.

 

 

ABSOLUTE CONTRAINDICATIONS TO USING WHOLE BODY CRYOTHERAPY

Pregnancy, severe Hypertension (BP> 180/100), acute or recent myocardial infarction (heart attack; need to be cleared for exercise), pacemaker, arrhythmia, symptomatic cardiovascular disease, acute or recent cerebrovascular accident (stroke; need to be cleared for exercise), uncontrolled seizures, fever, symptomatic lung disorders, bleeding disorders, active cancer (undergoing chemotherapy), Raynaud’s Disease, uncontrolled hypothyroidism, infection, claustrophobia, intolerance to cold, incontinence.

 

Possible Risks of Whole Body Cryotherapy/Cryofacial/Local Cryotherapy

Fluctuations in blood pressure (due to peripheral vasoconstriction, blood pressure may briefly increase by up to 10 points systolically during treatment. This effect should reverse after the end of the procedure, as peripheral circulation returns to normal, allergic reaction to extreme cold (rare), claustrophobia, temporary redness of skin, chilblain/skin burns/scarring (very rare), anxiety, activation of some viral conditions (cold sores) etc. due to stimulation of the immune system.

By submitting this form, I ACKNOWLEDGE AND REPRESENT that I have read and understand the foregoing , the information provided by me that is set forth above is true and correct, that I am at least eighteen (18) years of age and fully competent, and I am not suffering from any mental or legal disability.

Furthermore, I agree that I will comply with all instructions on the use of the cryo device and that I am using these services at my own risk. I agree to use all sessions within the term of the contract dates and understand that refunds are not given on unused portions of purchased packages. By signing below, I affirm that I have read and fully understand the risks in connection with cryotherapy, and I SIGN THIS DOCUMENT OF MY OWN FREE WILL.


I understand my risks and agree to all the terms and conditions listed above.