Haus of Wellness · Guest Waiver and Intake
Complete your details, health check, and acknowledgments before your visit.
Guest Information
Full legal name
*
First Name
Last Name
Date of birth
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Zip code
*
Emergency contact name
*
Emergency contact phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Health Screening and Experience
Do any of these apply to you?
*
Heart condition
High or low blood pressure
Pregnancy
Epilepsy or seizure history
Raynaud's
Recent surgery
Diabetes
None of these
If you checked anything above, please tell us more.
Have you cold plunged before?
*
Yes
No
Assumption of Risk and Release Acknowledgments
Assumption of risk: cold water immersion
*
[ATTORNEY-DRAFTED LANGUAGE GOES HERE. Cold water immersion specific.]
Assumption of risk: sauna and heat
*
[ATTORNEY-DRAFTED LANGUAGE GOES HERE. Heat and sauna specific.]
Assumption of risk: physical movement and outdoor conditions
*
[ATTORNEY-DRAFTED LANGUAGE GOES HERE. Movement and outdoor conditions specific.]
Photo and video release
*
I agree that Haus of Wellness and its partners may photograph and film me at this event and use that content across marketing, social, and partner channels.
Signature and Follow-Up
Signature
*
Date
*
-
Month
-
Day
Year
Date
Want to hear about the next one?
Yes
No
Submit
Submit
Should be Empty: