PERFORANCE & RECOVERY
TERMS & AGREEMENT
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I/parent/guardian understand and will NOT hold Strides of CNY, LLC, grounds, and facilities associated with Strides of CNY, LLC, and or any other facility responsible for any and all training accidents, injuries, claims of any kind and expenses incurred as a result of participation in this program.
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Strides of CNY, LLC staff will get prior consent before taking pictures and/or videos of you and/or your child for the sole purpose of marketing on the website and social media.
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Strides of CNY, LLC staff will get prior consent before administering skin fold tests* on you and/or child. Skin fold test is not a required test. *Skin fold test is a clinical method used to estimate an individual's percentage of body fat. In which a pinch of skin fold from one of seven particular body areas - pectoral, triceps, sub scapula, mid axilla, supra iliac, abdomen, and quadriceps.
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I/parent/guardian have been given medical clearance by a physician to participate in a vigorous training program provided by Strides of CNY, LLC and will not hold Strides of CNY, LLC responsible for any injury/illness/death that may result in my/our athlete's /client's participation with Strides of CNY, LLC.
CRYOTHERAPY
PRE-EXISTING CONDITIONS & AGREEMENTS
PRE-EXISTING CONDITIONS
Individuals are NOT PERMITTED to use the Cryotherapy if:
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Heart attack/bypass/valvular disease-past 6 months
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Pacemaker
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Congestive heart failure
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COPD
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Inplanted electrical devices
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Kidney conditions
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Seizure disorders
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Cold allergies/skin reactions to cold
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Blood disorders (hemophlia/blood clots)
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Major circulatory dysfunction
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Open wounds, sores, healing disorders
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Under the influence of drugs/alcohol
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CRYOTHERAPY RELEASE AGREEMENT​
PHYSICAL CAPACITY REQUIREMENTS
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Participation in a Cryotherapy session involves exposure to extreme cold temperature for a short period of time; not exceeding 3:30 mins/session.
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Staff provides instructions at first visit.
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Session should not take more then 5 minutes; entering and exitig the chamber room should be done quickly to allow for the next client.
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The chamber DOES NOT lock & you may walk out at any time.
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CRYOTHERAPY
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:
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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;
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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;
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Knowing the risks involved and the contraindications related, I nevertheless chose voluntarily to request permission to participate;
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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;
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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;
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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.​
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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.
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I understand that it is mandatory to wear protective garments for the entire Whole Body Cryotherapy (WBC) session as a safety precaution. Protective garmets include but not limited to ear protection (headbhand, winter hat or provided headphones), Hand protection (mittens or gloves), enclosed foot protection (tube socks, slippers or sneakers). I also understand that I should not remove Personal Protective Equipment (PPE) at anytime during my Whole Body Cryotherapy (WBC) session.
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I understand that wet/damp clothing or jewlery cannot be worn at anytime during a Whole Body Cryotherapy (WBC) session.
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I am 18 years of age or older. If under 18 years of age, parental consent is required. Customers are required to be a minimum of fourteen (14) years of age. If the client listed above is a minor (under 18 yrs of age) parental consent is given.
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I understand and agree to pay for any repairs or equipment that I damage as a result of my recovery system subscription.
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I understand and agree to pay $50 for a lost fob key.
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I understand and agree not to provide access to any other individual. If found abusing my privelages, I will be charged a $500 fee. Video cameras shall not be tampered with.
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SPORTS MEDICINE
TERMS & CONSENT
SPORTS MEDICINE | INFORMED CONSENT FOR TREATMENT
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As you have consulted with STRIDES OF CNT LLC (“Strides“) and have decided to receive Sports Medicine services from Michael Derecola, ATC,
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It is important that you, the patient, read this consent information carefully & obtain answers to any questions that you may have.
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Sports Medicine involves the use of several modalities of evaluation and treatment. Accordingly, at Strides of CNY, we use a variety of procedures and treatments to help us to try and improve your physical function. As with all forms of medical treatment, there are benefits and risks involved with sports medicine.
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As patient responses to a specific form of treatment can vary widely from patient to patient, it is not always possible to predict responses to a specific form of treatment. Therefore, Michael Derecola, ATC cannot guarantee any reaction or success to a given form of treatment. There is also a risk that your treatment may result in pain, injury, or may aggregative a previous condition.
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You have the right to inquire as to the form of treatment based upon your history, diagnosis, symptoms, and testing result. You may also discuss with your Certified Athletic Trainer the potential risks and benefits of a specific treatment and possible alternative treatments. You have the right to decline any portion of treatment at any time or during your treatment sessions. Your Certified Athletic Trainer stands ready to answer any questions you may have regarding a given course of treatment.
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SPORTS MEDICINE | CONSENT FOR CARE
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I hereby authorize and consent for Michael Derecola, ATC and/or any PT/PTA/students in training under the direction of the ATC as selected by him/her, to provide sports medicine services in accordance with the proposed treatment plan which has been explained to me in a way that I can understand. I understand that some of the sports medicine services provided to me at Strides may be performed by an ATC/PT other than those stated above.
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The above ATC has discussed with me my diagnosis, conditions, the reasons for & benefits of the proposed plan of sports medicine services, the reasonable likelihood of its success, the possible consequences of not choosing this plan, the possible risks associated with this plan, and possible alternatives and risk associated with those alternatives, as well as my goals of recovery and any potential problems that might arise during treatment.
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I understand the risks associated with sports medicine which may include the aggravation of previous injuries or the worsening of current conditions, as well as injuries common to the performance of exercise.
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I understand that I am giving this consent with the understanding that any treatment/procedure involves some risks & hazards, and that no guarantees have been made to me as to any treatments or examinations by Michael Derecola or the ATC/PT & supporting staff. The approximate duration of my treatment has been discussed with me by the ATC indicated above.
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CERTIFIED ATHLETIC TRAINER DECLARATION
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I have discussed the planned examination/assessment; evaluation, diagnosis, and prognosis/plan; the intervention/treatment to be provided; the nature of the proposed treatment; the benefits reasonably expected from the proposed treatment, together with the material risks & dangers of the proposed treatment; treatment alternatives, as well as the risks and benefits of such alternatives; & Michael Derecola, ATC cannot provide any form of guaranty.
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I have explained the contents, answered all questions, & all questions have been answered in a satisfactory manner. To the best of my knowledge, the Patient and/or the Patient’s Guardian has and/or have been adequately informed and has and/or have consented to this treatment/plan of care. As you have consulted with STRIDES OF CNT LLC (“Strides“) and have decided to receive Sports Medicine services from Michael Derecola, ATC.
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SPORTS MEDICINE | PATIENT CONSENT
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I HEREBY CERTIFY THAT I HAVE READ THIS FORM (OR HAVE HAD IT READ TO ME) AND FULLY UNDERSTAND THE ABOVE CONSENT. I HAVE HAD THE OPPORTUNITY TO ASK QUESTIONS, AND ALL OF MY QUESTIONS HAVE BEEN ANSWERED TO MY SATISFACTION. I DO NOT DESIRE ANY FURTHER EXPLANATION AND UNDERSTAND AND ACKNOWLEDGE THAT COMPLICATIONS CAN RESULT.
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I CERTIFY THAT I HAVE HAD SATISFACTORY OPPORTUNITY TO DISCUSS MY CONDITION, DIAGNOSIS, AND TREATMENT WITH THE ABOVE ATHHLETIC TRAINER WHO HAS FULLY EXPLAINED THE NATURE AND EXPECTED BENEFITS, ALTERNATIVES AND RISKS INVOLVED IN THE PROPOSED PLAN FOR PHYSICAL THERAPY SERVICES I HAVE CHOSEN AND ALL OF MY QUESTIONS HAVE BEEN ANSWERED TO MY SATISFACTION.
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I HAVE BEEN GIVEN ENOUGH INFORMATION AND FACTS UPON WHICH TO MAKE AN INFORMED DECISION ABOUT CHOSING THE PROPOSED PLAN FOR PHYSICAL THERAPY SERVICES, THE ALTERNATIVES, AND RISKS IN MY OWN LANGUAGE AND IN A MANNER THAT I CAN UNDERSTAND. I ACCEPT THAT NO GUARANTEES HAVE BEEN MADE TO ME CONCERNING THE PROPOSED PLAN FOR SPORTS MEDICINE SERVICES.
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I UNDERSTAND THAT THE PROPOSED PLAN FOR SPORTS MEDICINE SERVICES MAY NOT IMPROVE MY CONDITION AND MAY, IN FACT, WORSEN IT.
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I CERTIFY THAT I HAVE DISCLOSED COMPLETELY AND TRUTHFULLY ALL OF MY MEDICAL HISTORY; MY COMPLAINTS AND/OR AILMENTS; AND MY USE OF ALL PRESCRIPTION AND NON-PRESCRIPTION DRUGS, VITAMINS, MINERALS, AND DIETARY SUPPLEMENTS.
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I HAVE CAREFULLY READ AND FULLY UNDERSTAND THIS CONSENT FORM AND I VOLUNTARILY AUTHORIZE AND CONSENT TO THE PROPOSED PLAN FOR SPORTS MEDICINE SERVICES. DO NOT SIGN THE BELOW UNLESS YOU HAVE READ AND THROUGLY UNDERSTAND THIS CONSENT FORM.