Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you pregnant?

Yes

No

Are you taking any medications? *

Yes

No

Have you been diagnosed with any medical condition, such as anhidrosis, that may limit or prevent your ability to sweat? *

Yes

No

Do you have unstable angina? *

Yes

No

Have you had a recent heart attack? *

Yes

No

Do you have severe arterial disease? *

Yes

No

Have you been diagnosed with any other medical condition? *

Yes

No

If you answered“yes”to any of the above questions; have you consulted with your medical provider about using a full spectrum infrared sauna?

Yes

No

Signature *

INFRARED SAUNA AGREEMENT/ACKNOWLEDGEMENT 1. The use of drugs, medication or alcohol prior to or during the full spectrum infrared sauna session may lead to dizziness or unconsciousness. Clients using any medications must consult a physician or pharmacist prior to the use of the sauna. 2. Please consult your physician if you are in doubt of your ability to use the full spectrum infrared sauna for health reasons. 3. No one under the age of 18 is permitted in the full spectrum infrared sauna unless accompanied by a supervising adult. 4. Discontinue the use of the sauna if you feel light-headed, dizzy, or heat exhausted. 5. Sauna sessions should be limited to no more than 45 minutes and temperatures must stay below 150 degrees Fahrenheit. 6. Plastic water bottles are not permitted in the sauna. 7. Clientsusinganymedicationsmustconsultaphysicianorpharmacistpriortotheuseofthesauna. 8. Pregnant women should consult their physician prior to the use of the sauna. Excessive body temperatures have a potential for causing fetal damage during the early days of pregnancy. I acknowledge and voluntarily assume the risk of injury, accident, or death which may arise from the use of an infrared sauna. I, and any of my heirs, executors, representatives, or assignees hereby release all claims or liabilities for personal injury or property damages of any kind sustained while on the premises, during the use of the full spectrum infrared sauna and from any advice provided by an employee, independent contractor, or any representative. I agree that this Application and Waiver is in effect for all infrared sauna sessions and will not expire unless specifically requested by either party.

First Name

Last Name