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COCOON CONSENT FORM

This Release and Waiver is entered into by and between Y'Her Esthetics & Wellness Spa (“Provider”) and the undersigned client (“Client”), effective on the date written below. In consideration of Provider permitting Client to receive Cocoon FItness POD® sessions (“CFP session”) at Provider, Client agrees as follows:

1. Representation of Ability to Participate.

Client represents that he or she is of legal age and in satisfactory physical condition and has no medical condition that would prevent Client from receiving a CFP session. Client affirms he or she is properly hydrated and he or she has had the opportunity to inspect the facility, learn about the CFP session, and ask any questions he or she may have regarding the CFP session. Client affirms he or she has had the opportunity to consult his or her physician about any unique needs or
restrictions Client may have prior to receiving a CFP session. In the event of an accident, and at Client’s sole expense, Client hereby authorizes medical transportation to a medical facility or hospital.

2. Acknowledgement and Assumption of Risks

Client acknowledges he or she is aware a CFP session involves dry heat sauna combined with infrared heat and may require physical exertion that may be strenuous and may cause physical injury, and Client acknowledges that he or she is fully aware of the risks and hazards involved. Client fully accepts and assumes all such risks and all responsibility for losses, costs, and damages that may result from a CFP session.

3. Release

Client hereby releases, acquits, covenants not to sue and therefore discharges Provider, its owners, officers, administrators, employees, instructors, and/or agents, as well the owners, distributors, manufacturers, wholesalers, and
any other entity affiliated with CFP (collectively “Released Parties”) of and from any and all actions, and knowingly, voluntarily, and expressly waives any claim Client may have against the Released Parties for any injuries or damages
(known or unknown), property damage or loss of any kind, including death, whether such injury, damage, loss, or death was caused by the alleged negligence of Provider, another client, or any other person or cause, which Client may sustain
as a result of receiving a CFP session.

4. Indemnification

Client further voluntarily defends, indemnifies, and holds harmless the Released Parties from any and all liabilities or claims made as a result of or relating to Client receiving a CFP session, including attorney’s fees, for any accident, injury,
illness, death, loss, damage to person or property, or other consequences suffered by Client or any other person arising or resulting directly or indirectly from Client receiving a CRW session, whether such injury, death, loss, or damage was caused by the alleged negligence of Provider, another client, or any other person or cause.

5. Severability

Client further expressly agrees that the foregoing Release and Waiver is intended to be as broad and inclusive as is permitted by the laws of the United States, and the state in which it is signed, and that if any portion thereof is held invalid, it
is agreed that the balance shall, notwithstanding, continue in full legal force and effect.
Client affirms he or she has been fully informed and understands the use of CFP and has prepared for CFP session as indicated, and accepts personal responsibility for his or her session. Client is aware that the results achieved by this CFP session may vary from person to person, and Client acknowledges that no promises or guarantees have been made to Client as to the results of this session. Client understands Provider does not diagnose conditions or illnesses.

This Release and Waiver is governed by the laws of the State of New Jersey, and exclusive jurisdiction shall be in Passaic County, New Jersey. This Release and Waiver shall be binding on the Client’s assignees, heirs, next of kin, executors, and personal representatives.

CLIENT FURTHER AFFIRMS THAT NONE OF THE CONTRAINDICATIONS LISTED ON THE REVERSE OF THIS FORM THAT PREVENT PARTICIPATION IN RECEIVING A COCOON FITNESS POD® SESSION APPLY TO CLIENT. CLIENT REPRESENTS THAT HE OR SHE HAS CAREFULLY READ AND UNDERSTOOD THE CONTENTS OF THIS RELEASE AND WAIVER. CLIENT IS EXECUTING THIS FORM VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Contra-indications for Cocoon Fitness Pod

Please read carefully and check all that apply.

Cardiac Condtion
Hemophilia
Implanted Pacemaker
Infectious Skin Disease
Pregnancy
Multiple Sclerosis
Open Wounds
Fever
Several General Infection
Active Cancer
Lactation (Breast feeding)
Epilepsy
Low Blood Pressure

Consult your doctor before receiving a Cocoon Fitness Pod session if you have received care for any of the above listed conditions in the Contra-Indications area. You should NOT receive a Cocoon Fitness Pod session if you suffer from any of the conditions described above or any other condition where the use of an infrared heat session is contraindicated or if you are under the legal age in your jurisdiction.

 

IF YOU HAVE A HISTORY OF ANY OTHER MEDICAL CONDITION, OR YOU ARE TAKING PRESCRIPTION OR OVER THE COUNTER DRUGS, YOU SHOULD CONSULT YOUR PHYSICIAN BEFORE USING THE COCOON FITNESS POD.

 

Before and after a Cocoon Fitness Pod session, it is imperative to stay hydrated by drinking plenty of fluids. If any of the Contra-Indications apply to you, or you have a history of any other medical condition, or you are taking prescription or over the counter drugs, the section below must be signed by your physician prior to receiving a Cocoon Fitness Pod session.

Thanks for submitting! See you soon.

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223 Dayton Ave Clifton,
NJ 07011

Monday: CLOSED
Tuesday: 10 am -7 pm
Wednesday: 10 am - 7 pm
Thursday: 10 am - 7 pm
Friday: 10 am - 7 pm
Saturday: 10 am to 1 pm
Sunday: CLOSED

© 2023 by Y'Her Esthethis & Wellness Spa. 
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