RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT
In consideration of engaging in any way in any Cryoskin Australia services and using the Company’s equipment and facilities in relation thereto, I the undersigned, acknowledge, appreciate, and agree that:
1. There are certain inherent risks and dangers associated with receiving Services and my use of the Company’s equipment and facilities. At all times, I shall comply with all stated and customary terms, posted safety signs, rules, and verbal instructions given to me by staff. If in the subjective opinion of the Company’s staff, I would be at physical risk in receiving Services, I understand and agree that I may be denied access to Services until I furnish the Company with an opinion letter from my medical doctor, at my sole cost and expense, specifically addressing the Company’s concerns and stating that the Company’s concerns are unfounded.
2. I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, EVEN IF ARISING FROM THE NEGLIGENCE OF THE (RELEASEES) or others, and assume full responsibility for my participation in the Services. I hereby (1) agree to assume full responsibility for any and all injuries or damage which are sustained or aggravated by me in relation to my receiving of the Services.
3. I willingly agree to comply with terms and conditions for receiving the Services.I represent that: (a) I have no medical or physical condition that would prevent me from receiving the Services, (b) I do not have a physical or mental condition that would put me in any physical or medical danger, (c) I have not been instructed by a physician to not receive Services, (d) no warranty or guarantee, or other assurance, has been made to me covering the results of the Services, (e) knowing the risks involved I nevertheless chose to voluntarily request the Services.
4. I, for myself and on behalf of my heirs, assigns, personal representatives and next of kin, HEREBY RELEASE, INDEMNIFY, AND HOLD HARMLESS Cryoskin Australia, its officers, officials, agents and/or employees, owners and lessors of premises used to conduct the services (RELEASEES), from any and all responsibility, claims, demands, losses, costs, damages, and liability arising out of or related to any INJURY, DISABILITY OR DEATH I may suffer, or loss or damage to person or property, WHETHER ARISING FROM THE NEGLIGENCE OF THE RELEASEES OR OTHERWISE, to the fullest extent permitted by law.
I declare that I have read, understood and answered the questions in this form to the best of my knowledge. I have no known medical condition or allergies that may affect or induce a harmful reaction from a CryoSlimming (cryolipolysis) or a CryoToning/CryoFacelift treatment.
I understand that if I have a specific condition that is not mentioned in this form, I should first ask my doctor for medical advice. I understand that the operator might refuse to conduct a Cryoskin treatment as a precaution.
I understand that pregnant women or other persons with physical limitations should not use Cryoskin for safety reasons. Notwithstanding the foregoing (and by way of illustration only and not limitation) if any of the following apply to me or if I’m unsure for any reason, I hereby acknowledge the Company’s recommendation that I consult a medical physician before receiving Cryoskin Services:
• Severe Raynaud's Syndrome
• People who suffer from very poor circulation
• Severe Diabetes
I understand that sometimes localised redness can occur during the treatment, or the client might feel some discomfort or itching without consequences and often due to the reactions with certain cosmetic products. These side effects usually disappear soon after the treatment.The completed Client Registration Form is for informational purposes only. Cryoskin Australia and its staff are not medical professionals, and do not claim to be. We are Cryoskin 3.0 experts and hold the highest standard of safety, customer service and education. The Cryoskin 3.0 products and equipment have not been tested or approved by the FDA or any other government agencies for the treatment of any illness or disease. The information above is for the therapist’s record only and will not be misused or passed on to any third parties, unless with authorisation of the client.
I acknowledge and agree that no warranties or representations have been made to me regarding the results I will achieve from this treatments. I understand that results are individual and may vary.