Registration Form

WAIVER

RECOVERY SYSTEMS

Absolute Contraindications

Have you ever had a heart attack within the previous 6 months?
Do you have a pacemaker?
Have you had a heart bypass or valvular disease within the previous 6 months?
Do you have congestive heart failure?
Do you have chronic obstructive pulmonary disease (COPD)?
Do you have an intrathecal pain pump or any electro stimulation implant device? (i.e spinal stimulator implant)
Do you have any chronic or acute kidney conditions?

RELATIVE Contraindications

Do you have a history of seizure disorders?
Do you have cold allergies with known skin reactions to cold?
Do you have any blood disorders (such as hemophilia or blood clots)?
Do you have any major circulatory dysfunction (such as deep vein thrombosis)?

Other Risk Factors

Do you have any open wounds, sores, or healing disorders?
Are you under the influence of drugs or alcohol?

WAIVER & RELEASE AGREEMET

Physical Capability Requirements

Participation in a Whole Body Cryotherapy (WBC) session involves exposure to extreme cold temperature for a short period of time (not to exceed three and one-half (3:30) minutes per session). A staff member will provide istructions at your first visit Each session should not take more then 5 minutes; entering and exitig the chamber room should be done quickly to allow for the next client  You are free to walk out of the chamber at any time before your sessionn time is up.

Liability | Medical Release | Indemnification Agreement 

In consideration of being permitted by Strides of CY LLC to participate in their services, I hereby waive any and all claims and damages for personal injury or death which may occur as a result of my participation. I understand and agree that:

  1. This release is intended to discharge in advance Strides of CNY LLC, its officers, officials, employees, agents and volunteers from and against all liability arising out of or connected in any way with my participation in these activities;

  2. Participation may involve risk of serious injury, illness, disability or death and may result not only as a result of my actions, negligence or inaction, but also from the action, negligence or inaction of others, including their owners, officers officials employees, or volunteers and may result from the conditions of the facilities, equipment, or areas where such activities are being conducted;

  3. Knowing the risks involved and the contraindications related, I nevertheless chose voluntarily to request permission to participate;

  4. I will indemnify and hold harmless Strides of CNY, its owners, officers, officials, employees and volunteers from any loss, liability, damage, cost or expense, including litigation of any form, arising out of or connected in any manner with my participation in such activities;

  5. I am in good health and have no physical condition expressed in the ‘Contraindications’ or otherwise which would preclude me from safely participating in such activities;

  6. I understand and agree that this release is intended to be as broad and inclusive as permitted under the law of the State in which it is executed and that if any portion of this Hold Harmless, Release and Indemnification Agreement should be determined to be invalid, it is my intent that the remaining provisions shall continue in full force and effect.

I HAVE CAREFULLY READ THIS RELEASE INDEMNIFICATION AND HOLD HARMLESS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A POTENTIAL CONFLICT BETWEEN MYSELF, AND MY HEIRS AND STRIDES OF CNY I VOLUNTARILY AGREE TO EACH OF THE TERMS AND PROVISIONS HEREIN AND SIGN THIS OF MY OWN FREE WILL.

Do you give Strides of CNY, LLC consent to use pictures/videos of you/your child training for the sole purpose of marketing on the website and social media.

Thanks for submitting!

_edited.png