AIKA Wellness Ltd. Guest Intake and Liability Form

Full name*

First NameLast Name

Birth Date*

DayMonthYear

Address*

Street Address

Street Address Line 2

CityState / Province

Country

E-mail*

Phone Number*

Area CodePhone Number

Emergency contact*

First NameLast Name

Phone number*

Area CodePhone Number

What is your experience with The AIKA Cycle or other forms of Hot & Cold Therapy ?*

No experienceI have a little bit of experienceI have a consistent practice

AIKA Guest Questionnaire: *

	Yes	No
Has a doctor ever diagnosed you with a heart condition?
Do you have any physical or neurological health ailments that limit your physical activity?
In the past month, have you had any changes to your health?
Do you lose balance because of dizziness or do you ever lose consciousness?
Do you have bone or joint complications (for example, back, knee, or hip) that could be worsen by a change in your physical activity?
Are you on any prescribed medication?
Do you know of any reason why you should not expose yourself to hot or cold temperatures?

I consent to receiving SMS and email messages from AIKA*

YesNo

Photo or Video Release: I hereby grant permission to the Releasees to take photographic or video representations of me during my participation in AIKA Activities and to publish the photographs and video for advertising, promotional and marketing purposes. I waive any and all claims against the Releasees arising out of the Releasees use of my photographic or video representation of me, including claims relating to defamation or invasion of any copyright, privacy, personality or publicity rights. I agree not to claim compensation from the Releasees for the use of photographic or video representation of me during my participation in AIKA Activities

YesNo

RELEASE OF LIABILITY, WAIVER OF CLAIMS,

ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

(hereinafter the “Release Agreement”)

BY SIGNING THIS RELEASE AGREEMENT YOU WILL WAIVE OR GIVE UP CERTAIN LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE OR CLAIM COMPENSATION FOLLOWING AN ACCIDENT

PLEASE READ CAREFULLY

TO: Owners of AIKA Wellness ltd., and T.D. Tolmie & Company, as defined herein, take place; and all their related and associated companies (all of whom are hereinafter collectively referred to as the "Releasees").

DEFINITION:

In this Release Agreement the term "AIKA Activities" shall include all activities, events and services provided, arranged, organized, sponsored or authorized by the Releasees, including but not limited to: sauna, cold plunge, bucket shower, yoga, massage, consuming food and beverages, tending to a fire, chopping wood, breathwork, mountain creek access; use of premises where the AIKA activities take place; orientation and instruction sessions; and all other related activities.

ACKNOWLEDGEMENT

I am aware that AIKA Activities may not be supervised or monitored by professional staff.

ASSUMPTION OF RISK

The Participant accepts any risks of contracting COVID-19 by choosing to attend or utilize any and all amenities at the Releasees premises

OBLIGATIONS OF THE PARTICIPANT

The Participant shall be required to strictly abide by any and all policies of The Releasees concerning the control and spread of COVID-19, including without limitation all the provincial public health policies set on physical distancing and proper respiratory etiquette.

The Participant will not attend or use any amenities if they are experiencing any symptoms of COVID-19, if they have been in immediate contact with anyone who is experiencing any symptoms of COVID-19 or if they are otherwise under an obligation to self-isolate or remain in quarantine.

The Participant hereby releases AIKA Wellness ltd., and T.D. Tolmie & Company, the Owner, Operator and Occupier, its Directors, Officers, and Staff from any and all claims that the Participant has or may have in the future for: any loss or damage the Participant may suffer due to contracting COVID-19, including sickness or death, as a result of attending or using any or all amenities; and I am aware that participating in the AIKA Activities involve many risks, dangers and hazards which may result in serious injury or death including but not limited to: improper use of equipment; equipment failure; splinters, cuts, lacerations, fractures, burns, punctures or abrasions; collision with other persons; loss of balance or control; slips, trips and falls; failure to act safely or within one’s own ability; negligence of other persons; negligent first aid and

NEGLIGENCE ON THE PART OF THE RELEASEES. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF PARTICIPATING IN THE AIKA ACTIVITIES. I FREELY ACCEPT AND FULLY ASSUME ALL RISKS, DANGERS AND HAZARDS ASSOCIATED WITH THE AIKA ACTIVITIES AND THE POSSIBILITY OF PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS RESULTING THEREFROM.

RELEASE OF LIABILITY, WAIVER OF CLAIMS AND INDEMNITY AGREEMENT

1. TO WAIVE ANY AND ALL CLAIMS that I have or may in the future have against the Releasees AND TO RELEASE THE RELEASEES from any and all liability for any loss, damage, expense or injury including death that I may suffer, or that my next of kin may suffer, as a result of my participation in AIKA Activities DUE TO ANY CAUSE WHATSOEVER, INCLUDING NEGLIGENCE, BREACH OF CONTRACT OR BREACH OF ANY STATUTORY OR OTHER DUTY OF CARE, INCLUDING ANY DUTY OF CARE OWED UNDER THE OCCUPIERS LIABILITY ACT, R.S.B.C. 1996, c. 337, ON THE PART OF THE RELEASEES in respect of the provision of or the failure to provide any warnings, directions or instructions as to the use of the premises and the risks, dangers and hazards of participating in AIKA Activities. I UNDERSTAND THAT NEGLIGENCE INCLUDES FAILURE ON THE PART OF THE RELEASEES TO TAKE REASONABLE STEPS TO SAFEGUARD OR PROTECT ME FROM THE RISKS, DANGERS AND HAZARDS OF AIKA Activities;

2. TO HOLD HARMLESS AND INDEMNIFY THE RELEASEES from any and all liability for any property damage or personal injury to any third party resulting from my participation in AIKA Activities;

3. This Release Agreement shall be effective and binding upon my heirs, next of kin, executors, administrators, assigns and representatives, in the event of my death or incapacity;

4. This Release Agreement and any rights, duties and obligations as between the parties to this Release Agreement shall be governed by and interpreted solely in accordance with the laws of the Province of British Columbia and no other jurisdiction; and

5. Any litigation involving the parties to this Release Agreement shall be brought solely within the Province of British Columbia and shall be within the exclusive jurisdiction of the Courts of the Province of British Columbia.

In entering into this Release Agreement I am not relying on any oral or written representations or statements made by the Releasees with respect to the safety of AIKA Activities, other than what is set forth in this Release Agreement.

BY COMPLETING THIS FORM I CONFIRM THAT I CONFIRM THE FOLLOWING:

- I AM 19+ YEARS OF AGE OR AM SIGNING FOR SOMEONE UNDER THE AGE OF 19.

- I HEREBY ASSUME FULL RESPONSIBILITY FOR MY ACTIONS, RISKS, DANGERS, AND HAZARDS RESULTING FROM THE USE OF THE FACILITIES AND PARTICIPATION IN THE ACTIVITIES WHILE UNDER THE INFLUENCE OF ALCOHOL OR MIND ALTERING SUBSTANCES.

- I UNDERSTAND THAT AM GIVING UP CERTAIN RIGHTS WHICH I OR MY HEIRS, NEXT OF KIN, EXECUTORS, ADMINISTRATORS AND ASSIGNS MAY HAVE. I FREELY ACCEPT AND ASSUME ALL RISKS, DANGERS AND HAZARDS AND THE POSSIBILITY OF RESULTING PERSONAL INJURY, DEATH, PROPERTY DAMAGE OR LOSS DIRECTLY OR INDIRECTLY ASSOCIATED WITH MY PARTICIPATION IN THE AIKA ACTIVITIES.

-I HAVE READ THIS VOLUNTARY ASSUMPTION OF RISK, RELEASE AND INDEMNITY AGREEMENT (THE “WAIVER”) AND FULLY UNDERSTAND ITS CONTENTS AND VOLUNTARILY AGREE TO ITS TERMS.

Signature*

Date

RELEASE OF LIABILITY, WAIVER OF CLAIMS, ASSUMPTION OF RISKS AND INDEMNITY AGREEMENT

Liability waiver