float sixty intake & WAiver

Name *
Name
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Date of Birth
Date of Birth
Phone
Phone
Address
Address
How Did you Hear about Float Sixty?
Did you hear about Float Sixty from a current member*?We love to reward people for spreading the news! List that person's name and email or phone and we will contact them with a special thank you. *Member is someone who has a recurring membership for at least one float per month.
Tell Us......What Interests you about Floating?
Any additional therapy goals not listed above? List them here.
WAIVER AND RELEASE OF LIABILITY In consideration of the risk of injury while participating in Float/Relaxation/Meditation Sessions (the “Activity”), and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Float Sixty Corporation, located at 303 W. Erie Street, M100, Chicago, Illinois 60654, their affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors, and assigns, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity. I am voluntarily participating in the aforementioned Activity and I am participating in the Activity entirely at my own risk. I agree to indemnify and hold harmless Float Sixty Corporation against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney’s fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Float Sixty Corporation incurs any of these types of expenses, I agree to reimburse Float Sixty Corporation. I acknowledge that I have carefully read this “waiver and release” and fully understand that it is a release of liability. I expressly agree to release and discharge Float Sixty Corporation and all of its affiliates, managers, members, agents, attorneys, staff, volunteers, heirs, representatives, predecessors, successors and assigns, from any and all claims or causes of action and I agree to voluntarily give up or waive any right that I otherwise have to bring a legal action against Float Sixty Corporation for personal injury or property damage. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. In the event that any damage to equipment or facilities occurs as a result of my willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness. This Agreement was entered into at arm’s-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the Participant and Float Sixty Corporation agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into. In the event that any provisions contained within the Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause served does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.