Vibration Plate Release Form

Vibration Plate Release Form

Please read the following information and acknowledge that you understand and accept all provisions by signing below.
I understand that I have been advised to get approval from a physician prior to any physical exercise program.
Check Any that Apply... Contraindications (Cannot use devise if you have any of the following)

Cardiovascular Disease Pregnancy Acute Thrombosis Hip & Knee Replacements Pacemaker Tumors Acute Hernia Recent Surgical Woads Recent Infections Severe Migraine Epilepsy/Seizures Severe Diabetic Complications
Check That You have Read and agree to the following:

I certify that I do not have any of the contraindications outlined above, and I acknowledge that medical clearance is required if I have answered "YES" to any. I understand and agree that it is my responsibility to inform Shear Luxury of any condition or changes in my health, not and ongoing, which might affect my ability to exercise safely and with minimal risk of injury. I understand that should I feel light headed, faint, dizzy, nauseous, or experience pain/discomfort that I will stop my session and Shear Luxury Team. I understand that the results of Shear Luxury's Vibration Therapy may vary and cannot be guaranteed and that my progress depends on my effort and cooperation in and outside of the sessions. Clients under 18yrs old must have parent/guardian consent to use the Shear Luxury Whole Body Vibration Machines.
I hav read the contents of this release.informed consent form carefully and state that I am not aware of any medical condition or other reason that would prohibit me from using this service. I undrstand that I will not be allowed to exceed the maximum allowable time. I have been given adequate instructions for the proper use of equipment and understand the risks involved, and am using at my own risk. I hereby agree to release the owners, operators, and manufacturers from and damages that I might incur due to the use at this facility.
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Signature

Clear
Parent/Guardian if Under 18yrs old (write NA if this doesn't apply)

Clear
Date

Month Day Year
Date
Should be Empty: