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Call/Visit
Cold Dip Waiver form
To be filled out before attending a Cold Dip session
*
First name
*
Last name
*
Email
*
Phone number
Address
Birthday
Month
Day
Year
*
Name of emergancy contact
*
Phone number of emergancy contact
*
Health Advice for Cold Plunge: If you have a medical condition like heart disease, low/ high blood pressure or are pregnant, cold water therapy is NOT recommended. Please seek advice from a doctor.
I have had advice from a doctor
Not applicable
*I understand that I am responsible for my own health and wellbeing when using the cold plunge. I will listen to my body and to my coach.
Yes
*
Liability Waiver: I understand that using the cold plunge involves inherent risks including but not limited to personal injury, death & damage to property. I take responsibility and I do not hold Healing Possibilities responsible for any resulting harm.
I voluntarily assume all risks
*
Beginners should start with shorter durations in the cold plunge of around 1-2 mins. I will exit the cold plunge should I feel any discomfort beyond the usual cold sensation.
I am a beginner and will follow guidance
I regularly use cold plunge
*
Medical Waiver: Please disclose any current or past medical issues that may be relevant. Are you currently taking any medication? If none, please state not applicable.
*
Other Contraindications: Cold water therapy can cause hypothermia and cold water shock. I agree to listen to my coach so that I am able to spot the signs & follow guidance.
I agree to follow guidance
*
I allow any photos, videos or testimonials to be used by Julie of Healing Possibilities on social media & website.
Yes, I agree
Please do not use my images
I agree that my answers are correct & I have disclosed all relevant information.
Submit
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